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Updated: Apr 24, 2026
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Acute kidney injury after CABG versus PCI: an observational study using 2 cohorts
Tara I Chang1, Thomas K Leong2, Derek B Boothroyd1
1Stanford University School of Medicine, Stanford, California.
Insights
Acute kidney injury (AKI) is common after coronary revascularization. Coronary artery bypass grafting (CABG) significantly increases AKI risk compared to percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Nephrology
- Health Services Research
Background:
- Acute kidney injury (AKI) is a recognized complication following coronary revascularization procedures.
- Limited comparative data exists on AKI incidence between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate if multivessel CABG, as an initial revascularization strategy, presents a higher risk of AKI compared to PCI.
- To compare AKI incidence in patients undergoing CABG versus PCI for multivessel coronary artery disease.
Main Methods:
- Retrospective analysis of patients undergoing their first coronary revascularization.
- Utilized two cohorts: Kaiser Permanente Northern California and Medicare beneficiaries.
- Defined AKI based on serum creatinine changes or dialysis in respective cohorts.
Main Results:
- AKI incidence was 20.4% in the Kaiser Permanente cohort and 6.2% in the Medicare cohort.
- Coronary artery bypass grafting (CABG) showed a 2- to 3-fold increased odds of AKI compared to percutaneous coronary intervention (PCI).
- Less than 1% of AKI cases required dialysis.
Conclusions:
- Acute kidney injury (AKI) is prevalent after multivessel coronary revascularization.
- Coronary artery bypass grafting (CABG) is associated with a higher incidence of AKI than percutaneous coronary intervention (PCI).
- Consideration of AKI risk is crucial when selecting revascularization strategies; AKI prevention methods are needed.
Background:
Acute kidney injury (AKI) is a known complication after coronary revascularization, but few studies have directly compared the incidence of AKI after coronary artery bypass surgery (CABG) or after percutaneous coronary intervention (PCI) in similar patients.
Objectives:
The aim of this study was to investigate whether multivessel CABG compared with PCI as an initial revascularization strategy is associated with a higher risk for AKI.
Methods:
A retrospective analysis of patients undergoing first documented coronary revascularization was conducted using 2 complementary cohorts: 1) Kaiser Permanente Northern California, a diverse, integrated health care delivery system; and 2) Medicare beneficiaries, a large, nationally representative older cohort. AKI was defined in the Kaiser Permanente Northern California cohort by an increase in serum creatinine of ≥0.3 mg/dl or ≥150% above baseline and in the Medicare cohort by discharge diagnosis codes and the use of dialysis.
Results:
The incidence of AKI was 20.4% in the Kaiser Permanente Northern California cohort and 6.2% in the Medicare cohort. The incidence of AKI requiring dialysis was <1%. CABG was associated with a 2- to 3-fold significantly higher adjusted odds for developing AKI compared with PCI in both cohorts.
Conclusions:
AKI is common after multivessel coronary revascularization and is more likely after CABG than after PCI. The risk for AKI should be considered when choosing a coronary revascularization strategy, and ways to prevent AKI after coronary revascularization are needed.
