Abstract 8390: Contrast-Induced Nephropathy Independently Predicts Mortality After Cardiac Surgery
Background: Contrast induced nephropathy (CIN) is a predictor of poor outcome and long-term mortality. Coronary angiography is usually performed in close proximity to cardiac surgery. The goal of this investigation is to assess whether CIN also predicts post-surgical morbidity and mortality.
Methods: We evaluated 949 patients undergoing cardiac surgery at the Minneapolis VA Medical Center from 2004 to 2010. The cohort was divided in 3 groups according to change in serum creatinine 48 hours post-angiography (no increase, Δ <0.5 mg/dl, and Δ ≥0.5 mg/dl). Outcomes were operative mortality and post-operative acute kidney injury (AKI) using the AKI network and RIFLE (Risk, Injury, Failure, Loss, End-stage) definitions. Multivariable logistic-regression analysis adjusting for the VA mortality risk score was performed. Estimated glomerular filtration rate (eGFR) was calculated with the Modification of Diet in Renal Disease (MDRD) method.
Results: Mean age of the patients was 67 (±9.6) and 36% were diabetics. The mean (±SD) serum creatinine pre and post-angiogram were 1.18 (±0.39) and 1.11 (±0.41) mg/dl, with corresponding eGFR of 71.71 (±21) and 77.75 (±23) ml/m/1.73 m2. The incidence of post-operative outcomes in relation to Δ creatinine are presented in the table. In multivariable analysis, a rise in creatinine >0.5 mg after coronary angiogram was associated with a 5.6 fold increase in operative mortality after cardiac surgery (OR 5.6, 95% CI 1.3-23.7, p=0.02).
Conclusions: The development of CIN during diagnostic angiography is an independent predictor of post-operative kidney injury and mortality after cardiac surgery. Strategy-based studies to modify this risk are warranted.
- © 2011 by American Heart Association, Inc.