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Preoperative renal function as a predictor of survival after coronary artery bypass grafting: comparison with a
Albert H M van Straten1, Mohamed A Soliman Hamad, André A J van Zundert
1Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Preoperative renal dysfunction significantly impacts survival after coronary artery bypass grafting (CABG). Only severe dysfunction (creatinine clearance <30 mL/min) worsened outcomes, while mild dysfunction did not affect long-term survival.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Outcomes Research
Background:
- Preoperative renal dysfunction is a known predictor of mortality following revascularization procedures.
- Understanding the impact of varying degrees of renal function on long-term survival after coronary artery bypass grafting (CABG) is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between preoperative renal function and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 10,626 patients undergoing isolated CABG between 1998 and 2007.
- Patients stratified into four groups based on preoperative renal function (creatinine clearance).
- Comparison of observed survival with expected survival using age-, gender-, and year-matched general population data.
Main Results:
- Renal dysfunction was identified as a predictor of both early and late mortality.
- Patients with severe renal dysfunction (creatinine clearance <30 mL/min) exhibited significantly worse long-term survival compared to expected survival.
- Patients with mild to moderate renal dysfunction (creatinine clearance 60-90 mL/min) demonstrated long-term survival exceeding that of the general population.
Conclusions:
- The severity of preoperative renal dysfunction is directly related to poor long-term survival after CABG.
- A worse outcome compared to expected survival was observed only in patients with severe preoperative renal dysfunction.
Objective:
Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization. We studied how renal function affects long-term survival of patients after coronary artery bypass grafting.
Methods:
Early and late mortality were determined retrospectively among consecutive patients having isolated coronary bypass at a single Dutch institution between January 1998 and December 2007. Patients were stratified into 4 groups according to preoperative renal function. Expected survival was gauged using a general Dutch population group that was obtained from the database of the Dutch Central Bureau for Statistics; for each of our renal function groups, a general population group was assembled by matching for age, gender, and year of operation.
Results:
After excluding 122 patients lost to follow-up, 10,626 patients were studied; in 10,359, preoperative creatinine clearance could be calculated. Multivariate logistic regression and Cox regression analysis identified renal dysfunction as a predictor for early and late mortality. When long-term survival of patient groups was compared with expected survival, only patients with a creatinine clearance less than 30 mL x min(-1) showed a worse outcome. Patients with a creatinine clearance between 60 and 90 mL x min(-1) had a long-term survival exceeding the expected survival.
Conclusions:
Severity of renal dysfunction was related to poor survival. When compared with expected survival, however, patients having coronary bypass had a worse outcome only when severe preoperative renal dysfunction was present.
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