Abstract 15609: The Effect of Contrast-induced Acute Kidney Injury in High Risk Patients Undergoing Cardiac Surgery
Background: Contrast-induced acute kidney injury (CI-AKI) is an acute complication following coronary angiography and is associated with higher rates of AKI in patients who have follow-on cardiac surgery.
Objective: We investigated the joint effect of CI-AKI, Thakar Acute Renal Failure (ARF) score, and time between coronary angiogram with iso-osmolar iodixanol contrast and cardiac surgery. The primary outcome was cardiac surgery-acquired acute kidney injury (CSA-AKI).
Methods: We obtained data from the Texas Quality Initiative (TQI), Dallas Fort Worth Hospital Council, and the Baylor Health Care System from 2008 to 2014. There were 965 patients who underwent cardiac surgery at a Baylor facility, had data captured by TQI, and had an angiogram with iodixanol at a Baylor facility <180 days prior to surgery. Using a 0.3 mg/dL rise or a 50% increase from baseline-to-peak serum creatinine to define AKI, we built a multivariate logistic model via stepwise selection to examine the joint relationship of CI-AKI, Thakar ARF group and time between angiography.
Results: Patient features are in Table 1; 402 (41.7%) patients had CSA-AKI; 126 (13.1%) had CI-AKI. The model revealed Thakar ARF group and CI-AKI as significant contributors to CSA-AKI (p<0.0001, p=0.0008). Having CI-AKI doubled the odds of CSA-AKI (Adj. OR = 2.0, 95% CI = 1.3-3.0, p=0.0008). Thakar ARF groups 2, 3 and 4 were associated with 1.6 (95% CI=1.2-2.1, p<0.0001), 2.9 (95% CI 1.9-4.4, p<0.0001) and 9.2 (95% CI 3.4-32.1, p<0.0001) fold increases in CSA-AKI compared to group 1. Pearson and Hosmer-Lemeshow tests confirmed model fit (p-values = 0.1835 and 0.1587). Time between coronary angiography and surgery was not a risk factor for CSA-AKI.
Conclusion: Patients with higher Thakar ARF scores and CI-AKI were at greater risk for CSA-AKI. When CI-AKI and pre-surgical risk were taken as covariates, there was no relationship between time from coronary angiography with iodixanol to cardiac surgery on the CSA-AKI outcome.
Author Disclosures: K.M. Tecson: None. B.L. Hamman: None. J.W. Choi: None. P. Garg: None. O.A. Olugbode: None. J.M. Schussler: None. R.C. Stoler: Consultant/Advisory Board; Modest; Boston Scientific. Consultant/Advisory Board; Significant; Medtronic. A. Vasudevan: None. C.E. Velasco: None. P.A. McCullough: None.
- © 2016 by American Heart Association, Inc.