Abstract 14402: Relationship of Time Interval Between Elective Coronary Artery Bypass Surgery and Cardiac Catheterization With the Risk of Post-Surgical Acute Kidney Injury
Background: Few prior studies have suggested that the time between cardiac catheterization (CATH) and subsequent cardiac surgery is inversely related to post-operative acute kidney injury (AKI). However, these studies because of small number of patients were unable to adequately account for patient case-mix and included those undergoing elective as well as urgent/emergent/salvage surgery.
Methods and Results: We examined data on 2441 consecutive patients that underwent an elective coronary artery bypass surgery (CABG) after CATH at Duke University Medical Center. The influence of time interval between CATH and CABG on post-operative AKI (defined as increase in post-CABG serum creatinine ≥50% above the baseline and/or the need for dialysis) was evaluated using multivariable logistic regression modeling. AKI occurred in 17.1% of CABG patients. Time interval between CATH and CABG was inversely and independently associated with increased risk of AKI (adjusted OR 0.92, 95% CI 0.85–0.99, p=0.027). The risk of AKI was highest in patients in whom CABG was performed </=1day of CATH (Table) despite the fact that (compared with those undergoing surgery later) the patients having CABG </=1 day were younger, had lower comorbidities (diabetes, peripheral vascular disease, prior CABG, prior myocardial infarction, chronic obstructive airway disease, presenting heart failure and baseline creatinine) and had lowest amount of contrast agent used during the preceding CATH.
Conclusions: Time interval between CATH and CABG was inversely associated with increased risk of post-operative AKI with highest risk in those operated </=1 day of CATH despite their lowest risk profile. These findings suggest that delaying CABG beyond 24 hours of exposure to contrast agents (when feasible) has a significant potential for reducing the incidence of post-operative AKI in those undergoing elective CABG.
- © 2010 by American Heart Association, Inc.