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(Circulation. 2006;114:I-409 – I-413.)
© 2006 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Perioperative Increases in Serum Creatinine Are Predictive of Increased 90-Day Mortality After Coronary Artery Bypass Graft Surgery

Jeremiah R. Brown, PhD; Richard P. Cochran, MD; Lawrence J. Dacey, MD; Cathy S. Ross, MS; Karyn S. Kunzelman, PhD; Robert F. Dunton, MD; John H. Braxton, MD; David C. Charlesworth, MD; Robert A. Clough, MD; Robert E. Helm, MD; Bruce J. Leavitt, MD; Todd A. MacKenzie, PhD; Gerald T. O’Connor, PhD, DSc, for the Northern New England Cardiovascular Disease Study Group

From Center for the Evaluative Clinical Sciences (J.R.B., C.S.R., T.A.M., G.T.O.), Dartmouth Medical School, Lebanon, NH; Central Maine Medical Center (R.P.C.), Lewiston, Me; Dartmouth-Hitchcock Medical Center (L.J.D., K.S.K.), Lebanon, NH; Concord Hospital (R.F.D.), Concord, NH; Maine Medical Center (J.H.B.), Portland, Me; Catholic Medical Center (K.S.K., D.C.C.), Manchester, NH; Eastern Maine Medical Center (R.A.C.), Bangor, Me; Portsmouth Regional Hospital (R.E.H.), Portsmouth, NH; Fletcher Allen Health Care (B.J.L.), Burlington, Vt.

Correspondence to Jeremiah R. Brown, Rubin 505; DHMC, One Medical Center Drive, Lebanon, NH 03756. E-mail: Jeremiah.R.Brown{at}Dartmouth.EDU

Background— Impaired renal function after coronary artery bypass graft (CABG) surgery is a key risk factor for in-hospital mortality. However, perioperative increases in serum creatinine and the association with mortality has not been well-studied. We assessed the hypothesis that perioperative increases in creatinine are associated with increased 90-day mortality.

Methods and Results— We studied 1391 patients in northern New England undergoing CABG in 2001 and evaluated preoperative and postoperative creatinine. Patients with preoperative dialysis were excluded. Data were linked to the National Death Index to assess 90-day survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by percent increase in creatinine from baseline: <25%, 25% to 49%, 50% to 99%, 100%. We assessed 90-day survival and calculated adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for creatinine groups, adjusting for age and sex. Patients with the largest creatinine increases (50% to 99% or 100%) had significantly higher 90-day mortality compared with patients with a smaller increase (<50%; P<0.001). Adjusted HR and 95% CI confirmed patients in the higher 2 groups had an increased risk of mortality compared with the <25% (referent); however, the 25% to 49% group was not different from the referent: 1.80 (95% CI: 0.73 to 4.44), 6.57 (95% CI, 3.03 to 14.27), and 22.10 (95% CI, 11.25 to 43.39).

Conclusions— Patients with large creatinine increases (50%) after CABG surgery have a higher 90-day mortality compared with patients with small increases. Efforts to identify patients with impaired renal function and to preserve renal function before cardiac surgery may yield benefits for patients in the future.

Key Words: coronary artery bypass graft • creatinine • kidney • surgery • survival