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Renal dysfunction after myocardial revascularization.

Pedro E Antunes1, David Prieto, J Ferrão de Oliveira

  • 1Centre of Cardiothoracic Surgery, University Hospital, 3049 Coimbra, Portugal. antunes.cct.huc@mail.telepac.pt

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 24, 2004
PubMed
Summary

Postoperative renal dysfunction (PRD) after coronary artery bypass grafting (CABG) significantly increases mortality and hospital stay. Even mildly elevated preoperative creatinine levels are a major risk factor for adverse outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Critical Care Medicine

Background:

  • Postoperative renal dysfunction (PRD) is a significant complication after coronary artery bypass grafting (CABG).
  • Identifying risk factors and outcomes associated with PRD is crucial for improving patient care.
  • Pre-existing mild renal impairment may impact outcomes in patients undergoing CABG.

Purpose of the Study:

  • To evaluate the incidence of PRD in patients undergoing isolated CABG without pre-existing renal disease.
  • To analyze pre and intraoperative risk factors for PRD development.
  • To determine the impact of PRD on perioperative mortality and hospital length of stay, including the effect of mildly elevated serum creatinine.

Main Methods:

  • A cohort of 2445 consecutive patients undergoing isolated CABG between July 1996 and December 2001 were analyzed.

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  • Patients had no pre-existing renal disease (creatinine ≤2.0 mg/dl, no dialysis).
  • PRD was defined as a postoperative serum creatinine level ≥2.1 mg/dl with an increase of ≥0.9 mg/dl from baseline. Univariate and multivariate analyses were performed.

    • Main Results:

    • The incidence of PRD was 5.6%, with a 30-day mortality of 0.7% in the overall cohort.
    • Patients with PRD experienced significantly higher mortality (8.8% vs. 0.1%) and longer hospital stays (11.0 vs. 7.6 days).
    • Independent predictors of PRD included age, angina class III/IV, cardiopulmonary bypass time, and higher preoperative serum creatinine levels (1.3-2.0 mg/dl).

    Conclusions:

    • PRD, even in patients without prior renal dysfunction, dramatically increases mortality, morbidity, and length of stay after CABG.
    • Mildly elevated preoperative serum creatinine levels (>1.2 mg/dl) are significant independent predictors of increased perioperative mortality and morbidity.
    • Risk stratification and management strategies should consider preoperative renal function in CABG patients.