Abstract 19550: Incidence, Correlates and Impact of Acute Kidney Injury in Diabetic Patients With Multivessel Disease Undergoing Coronary Revascularization: Results From the FREEDOM Trial
Introduction: The incidence and prognostic significance of acute kidney injury (AKI) in diabetic patients with multivessel coronary artery disease undergoing coronary revascularization is not well known. The current analysis included patients randomized to PCI vs. CABG as part of the FREEDOM trial. We sought to examine the impact of AKI and its predictors in diabetic patients with multivessel coronary artery disease undergoing PCI vs. CABG.
Hypothesis: AKI has clinical impact in both PCI and CABG treated patients.
Methods: We conducted a pre-specified subgroup analysis of the FREEDOM trial to examine the therapeutic efficacy of CABG versus PCI among patients stratified by the presence (n=210) or absence (n=1645) of AKI. Renal function was calculated using the CKD-EPI formula and AKI was defined using the AKIN network definition (greater than 0.3mg/dl or 50% increase). We grouped together stages 1-3. Baseline characteristics and clinical outcomes were compared between PCI and CABG groups according to the presence or absence of AKI. The primary endpoint was the composite occurrence of all-cause death, stroke or myocardial infarction (major adverse cardiovascular events; [MACCE]) at 5 years of follow-up.
Results: AKI was more prevalent in patients undergoing CABG compared to PCI (14.3% vs. 8.5%, p<0.001). The occurrence of more advanced AKI (stage 2 or 3) was more common in patients undergoing CABG (3.3% vs. 1.9%, p=0.06).History of PVD, insulin treated diabetes, non-use of ACE/ARB, and renal impairment were independent predictors of AKI. AKI was associated with an approximate 2-fold higher risk for MACCE at 5 years (30% vs. 17%, p<0.001), an effect that remained large and significant irrespective of CABG (HR=1.88 95% CI 1.26-2.80, p=0.002) or PCI (HR=2.23 95% CI 1.49-3.33, p<0.0001). However, the long-term comparison of CABG versus PCI was not statistically different with and without AKI in the FREEDOM trial (p-interaction =0.69).
Conclusions: Although AKI was more prevalent in patients undergoing CABG, the impact of AKI on MACCE risk was substantial irrespective of revascularization strategy. Preventive Strategies to identify patients at risk for AKI are warranted to mitigate the long-term effects of this complication.
Author Disclosures: Y. Arbel: None. M. Farkouh: Research Grant; Modest; Amgen. U. Buber: None. T. Hamza: None. F.S. Siami: None. V. Fuster: None.
- © 2016 by American Heart Association, Inc.