Abstract 3243: Influence of Perioperative Creatinine Rise on Long-term Survival After Off-pump Coronary Artery Surgery
Background: Although off-pump coronary artery (OPCAB) has been shown to potentially decrease perioperative morbidity of coronary revascularization, perioperative transitory renal insufficiency is still a potential complication. Renal insufficiency affects operative mortality and can impact on long-term survival of patients benefiting of off-pump coronary revascularization.
Aims of the study: To evaluate how a temporary rise (Δ50) in perioperative creatinine level could be an indicator of long-term mortality following OPCAB surgery.
Methods: We used our prospective data base of 1000 consecutive OPCAB patients operated between September 1996 and March 2004 representing 98% of all coronary revascularizations during the same time frame. Follow-up was complete in 98% of the cohort. Average follow-up was 60±24 months.
Results: Average age was 64±10 years; triple vessel disease was present in 73%, unstable angina in 69%, emergency surgery in 5.3%. On average 3.2 grafts/patient were performed. Operative 30-day mortality was 1.7%. Overall survival at 8 years was 73±3.5% and cardiac survival was 94±1.3%. A postoperative transitory rise of 50 mM (Δ50) in creatinine plasmatic level occurred in 9% of the patients (Δ50 group). The group with transient rise had a higher preoperative creatinine level (p<0.0001), was older (p<0.001), prevalence of diabetes (p=0.01), hypertension (p=0.005), chronic heart failure (CHF) (p=0.007), peripheral vascular disease (p<0.001), and prior myocardial infarction (PMI) (p=0.03) was also higher. Operative mortality was similar (p=0.02) but 8-year survival was significantly decreased in transitory rise (Δ50) group (45±1% vs.78±3%; p<0.0001). By Cox regression analysis the Δ50 remained a significant indicator of long-term mortality (HR 1.8) even after normalization for age, sex, diabetes, chronic obstructive pulmonary disease, hypertension, cardiac failure, PMI, CHF, peripheral vascular disease, left ventricular ejection fraction, left main disease, and preoperative creatinine level.
Conclusion: Perioperative Δ50 creatinine PMI is a strong predictor of long-term mortality in OPCAB surgery.