Abstract 14859: Off-Pump Coronary Artery Bypass Grafting (OPCAB) Improves in-Hospital Outcomes in Patients With Mild to Moderate but Not Severe Chronic Kidney Disease (CKD) — Insights From the CREDO-Kyoto Registry -
Background: The use of cardiopulmonary bypass often deteriorates postoperative renal function particularly in patients with CKD. However, OPCAB may alleviate the renal damage compared with on-pump CABG (ONCAB). The purpose of the study was to elucidate the impact of the preoperative degree of CKD on long-term outcomes after CABG, and to investigate the efficacy of OPCAB.
Methods and Results: Between 2000 and 2002, a total of 2480 patients undergoing ONCAB (n=1384) or OPCAB (n=1096) were enrolled to the CREDO-Kyoto registry. The preoperative degree of CKD was classified by creatinine clearance (CCr: ml/min) estimated by the Cockroft-Gault equation: Normal (CCr≥90), Mild CKD (90>CCr≥60), Moderate (60>CCr≥30), Severe (30>CCr≥15), and End-stage (15>CCr or dialysis). Preoperative CCr was not different between patients received ONCAB and OPCAB (66 ± 30 vs. 64 ± 31, p=0.09). <In-hospital outcomes> Adjusted in-hospital mortality increased proportionally with the degree of CKD (Table, reference=Normal). OPCAB was associated with better survival than ONCAB in patients with mild CKD (odds ratio [95% CI]; 20.22 [2.01–203.1], p=0.01) and moderate CKD (2.76 [0.97–7.86], p=0.06). There were no differences in mortality in severe or end-stage CKD (p=0.98 each). <Follow-up outcomes> Kaplan-Meier analysis showed long-term survival is progressively worse across degree of CKD (p<0.001, Figure). Adjusted follow-up mortality also increased with the preoperative degree of CKD (Table). There were no differences in the follow-up mortality between ON- and OPCAB regardless of the degree of CKD (p=0.11–0.64).
Conclusions: Preoperative higher degree of CKD is associated with worse in-hospital and follow-up outcomes after CABG. OPCAB is associated with better in-hospital outcomes than ONCAB in patients with mild to moderate CKD, but not in severe or end-stage CKD. Follow-up outcomes are similar between ONCAB and OPCAB regardless of the preoperative degree of CKD.
- © 2010 by American Heart Association, Inc.