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Clinical SYNTAX Score Can Predict Acute Kidney Injury following On-Pump but Not Off-Pump Coronary Artery Bypass
Mete Gursoy1, Abdulkadir Faruk Hokenek1, Egemen Duygu2
1Department of Cardiovascular Surgery, Istanbul, Turkey.
Insights
The clinical SYNTAX score (CSS) effectively predicts acute kidney injury (AKI) after on-pump coronary artery surgery, but not off-pump procedures. This finding aids in stratifying patient risk for AKI following cardiac surgery.
Area of Science:
- Cardiology
- Nephrology
- Surgical Risk Stratification
Background:
- Coronary artery disease (CAD) complexity is often overlooked in risk assessment.
- Acute kidney injury (AKI) is a significant post-cardiac surgery complication.
- The clinical SYNTAX score (CSS) assesses CAD complexity.
Purpose of the Study:
- To evaluate the discriminative ability of the CSS for predicting AKI.
- To compare AKI risk between on-pump and off-pump coronary artery bypass grafting (CABG).
- To determine if CSS predicts AKI in different CABG modalities.
Main Methods:
- Retrospective review of 193 patients undergoing CABG (89 off-pump, 104 on-pump).
- Preoperative data and CSS were collected.
- Postoperative AKI was classified using RIFLE criteria.
Main Results:
- AKI incidence was higher in the on-pump group (27.8%) versus off-pump (15.7%).
- CSS did not differentiate AKI risk in off-pump CABG (AUC=0.500).
- CSS significantly predicted AKI in on-pump CABG (AUC=0.840), with higher scores in AKI patients.
Conclusions:
- The CSS is a valuable tool for predicting postoperative AKI in on-pump CABG.
- CSS may not be suitable for AKI risk stratification in off-pump CABG.
- Integrating CSS can improve risk assessment for on-pump cardiac surgery patients.
Background:
The complexity of coronary artery disease is usually a neglected factor in risk stratification systems. We aimed to analyze the discriminative ability of the clinical SYNTAX score (CSS) for acute kidney injury (AKI) following on- and off-pump coronary artery surgery.
Methods:
A total of 193 patients were reviewed in this study. Patients were divided into two groups according to the surgical procedure (group I: off-pump coronary artery bypass grafting, n = 89; group II: on-pump coronary artery bypass grafting, n = 104). Preoperative demographic data, the CSS and postoperative renal functions were evaluated. The postoperative AKI classification was made using the RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) criteria.
Results:
Postoperative AKI occurred in 14 of 89 patients (15.7%) in group I and in 29 of 104 patients in group II (27.8%; p = 0.046). The CSS did not vary much between the groups (31.52 ± 13.08 vs. 29.89 ± 15.70; p = 0.638). In group I, the CSS was not different between patients with AKI and those without AKI (30.167 ± 3.93 vs. 31.91± 14.75; p = 0.78). In group II, the CSS was 36.85 ± 18.33 in patients with AKI and 28.02 ± 12.32 in those without, and the difference was significant (p = 0.02). The discriminative ability of the CSS for postoperative AKI using the AUC analysis was 0.500 in group I and 0.840 in group II.
Conclusion:
The CSS may be a simple and successful means of risk prediction of postoperative AKI in on-pump coronary artery surgery.
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