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Impact of renal dysfunction on long-term survival after isolated coronary artery bypass surgery

Ye Lin1, Zhe Zheng, Yan Li

  • 1Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

The Annals of Thoracic Surgery
|March 28, 2009
PubMed

Insights

The Cockcroft-Gault formula best predicts in-hospital mortality after coronary artery bypass grafting (CABG), outperforming the MDRD equation and serum creatinine. This estimated glomerular filtration rate (eGFR) method improves risk assessment for patient outcomes.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Statistics

Background:

  • Preoperative renal dysfunction is a key predictor of adverse cardiovascular events post-coronary artery bypass grafting (CABG).
  • Serum creatinine was historically used, but estimated glomerular filtration rate (eGFR) is now recommended.
  • The predictive accuracy of the Cockcroft-Gault formula versus the MDRD equation for long-term outcomes after CABG remains unclear.

Purpose of the Study:

  • To compare the predictive effectiveness of the Cockcroft-Gault formula, MDRD equation, and serum creatinine.
  • To evaluate these markers for both in-hospital and long-term mortality following CABG.

Main Methods:

  • Retrospective review of 5559 patients undergoing isolated CABG (1999-2005).
  • Utilized receiver operating characteristic (ROC) curves and Cox regression analysis.
  • Compared prediction accuracy for in-hospital and long-term mortality.

Main Results:

  • The Cockcroft-Gault formula demonstrated superior accuracy for predicting in-hospital mortality (AUC=0.755, p<0.001).
  • eGFR by Cockcroft-Gault independently predicted in-hospital (OR=4.51) and long-term mortality (HR=1.54).
  • Both eGFR formulas outperformed serum creatinine in risk assessment.

Conclusions:

  • Both eGFR formulas offer better risk assessment than serum creatinine for CABG patients.
  • The Cockcroft-Gault formula is superior to the MDRD equation for predicting in-hospital mortality post-CABG.
Abstract

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