Skip to main content
Erschienen in: Heart and Vessels 1/2021

11.07.2020 | Original Article

Acute kidney injury following coronary artery bypass grafting and control angiography: a comprehensive analysis of 221 patients

verfasst von: Linus Wintgen, Abdul Rahman Dakkak, Mosab Al Shakaki, Konrad Wisniewski, Fausto Biancari, Sven Martens, Andreas Rukosujew, Angelo Maria Dell’Aquila

Erschienen in: Heart and Vessels | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Postoperative coronary angiography offers the basis for prompt management of ischemic complications after coronary artery bypass grafting (CABG). Little is known about the effects of postoperative angiography on renal function. The current study aims to assess the incidence and risk factors for acute kidney injury (AKI) following postoperative coronary angiography. A total of 221 CABG patients (mean age, 67 ± 8 years) underwent postoperative coronary angiography due to perioperative myocardial infarction (PMI). AKI was defined according to the KDIGO criteria. Logistic regression analyses were performed to find out risk factors responsible for AKI and to ascertain significant associations between AKI and in-hospital death. Mean delay from CABG operation to postoperative angiography was 1.4 ± 1.0 days. AKI occurred in 79/221 (36%) patients. Mean serum-creatinine (sCr) values peaked on the first day after the angiography and reached the lowest level at the fourth day. In the multivariable analysis, the following variables were independent predictors for AKI: postoperative peak values of CK-MB (p = 0.049, OR 1.03, 95% CI 1.00–1.06 per 10 U/l), EuroSCORE I (p = 0.011, OR 1.18, 95% CI 1.04–1.35), and AKI before re-angiography (p = 0.004, OR 3.50, 95% CI 1.51–8.16), whereas a delayed angiography (p = 0.031, OR 0.69, 95% CI 0.49–0.97) was protective against AKI. Patients with post-angiography AKI had a significantly higher mortality after multivariable adjustment than patients without AKI (15.5% vs. 2.11%, p = 0.001, OR 5.42, 95% CI 1.35–21.75). Over one-third of patients who undergo postoperatively angiography develop AKI. The occurrence of AKI must be considered during the decision-making prior to coronary angiography, especially in patients presenting the identified risk factors for AKI.
Literatur
1.
Zurück zum Zitat Preußer M, Landwehrt J, Mastrobuoni S, Biancari F, Dakkak AR, Alshakaki M, Martens S, Dell'Aquila AM (2018) Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: a single-centre experience. Interact Cardiovasc Thorac Surg 26(2):237–242PubMedCrossRef Preußer M, Landwehrt J, Mastrobuoni S, Biancari F, Dakkak AR, Alshakaki M, Martens S, Dell'Aquila AM (2018) Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: a single-centre experience. Interact Cardiovasc Thorac Surg 26(2):237–242PubMedCrossRef
2.
Zurück zum Zitat Davierwala PM, Verevkin A, Leontyev S, Misfeld M, Borger MA, Mohr FW (2013) Impact of expeditious management of perioperative myocardial ischemia in patients undergoing isolated coronary artery bypass surgery. Circulation 128:226–234CrossRef Davierwala PM, Verevkin A, Leontyev S, Misfeld M, Borger MA, Mohr FW (2013) Impact of expeditious management of perioperative myocardial ischemia in patients undergoing isolated coronary artery bypass surgery. Circulation 128:226–234CrossRef
3.
Zurück zum Zitat Thielmann M, Massoudy P, Jaeger BR, Neuhäuser M, Marggraf G, Sack S, Erbel R, Jakob H (2006) Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur J Cardiothorac Surg 30(1):117–125PubMedCrossRef Thielmann M, Massoudy P, Jaeger BR, Neuhäuser M, Marggraf G, Sack S, Erbel R, Jakob H (2006) Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur J Cardiothorac Surg 30(1):117–125PubMedCrossRef
4.
Zurück zum Zitat Repossini A, Tespili M, Saino A, Di Bacco L, Giroletti L, Rosati F, Bisleri G, Muneretto C (2014) Hybrid coronary revascularization in 100 patients with multivessel coronary disease. Ann Thorac Surg 98(2):578–576CrossRef Repossini A, Tespili M, Saino A, Di Bacco L, Giroletti L, Rosati F, Bisleri G, Muneretto C (2014) Hybrid coronary revascularization in 100 patients with multivessel coronary disease. Ann Thorac Surg 98(2):578–576CrossRef
5.
Zurück zum Zitat Dardashti A, Ederoth P, Algotsson L, Brondén B, Bjursten H (2014) Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery. J Thorac Cardiovasc Surg 147(2):802–803CrossRef Dardashti A, Ederoth P, Algotsson L, Brondén B, Bjursten H (2014) Incidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery. J Thorac Cardiovasc Surg 147(2):802–803CrossRef
6.
Zurück zum Zitat Gallagher S, Jones DA, Lovell MJ, Hassan S, Wragg A, Kapur A, Uppal R, Yaqoob MM (2014) The impact of acute kidney injury on midterm outcomes after coronary artery bypass graft surgery: a matched propensity score analysis. J Thorac Cardiovasc Surg 147(3):990–991CrossRef Gallagher S, Jones DA, Lovell MJ, Hassan S, Wragg A, Kapur A, Uppal R, Yaqoob MM (2014) The impact of acute kidney injury on midterm outcomes after coronary artery bypass graft surgery: a matched propensity score analysis. J Thorac Cardiovasc Surg 147(3):990–991CrossRef
7.
Zurück zum Zitat Medalion B, Cohen H, Assali A, Vaknin Assa H, Farkash A, Snir E, Sharoni E, Biderman P, Milo G, Battler A, Kornowski R, Porat E (2010) The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting. J Thorac Cardiovasc Surg 139(6):1539–1541PubMedCrossRef Medalion B, Cohen H, Assali A, Vaknin Assa H, Farkash A, Snir E, Sharoni E, Biderman P, Milo G, Battler A, Kornowski R, Porat E (2010) The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting. J Thorac Cardiovasc Surg 139(6):1539–1541PubMedCrossRef
8.
Zurück zum Zitat Kellum J, Lameire N, Aspelin P, Barsoum RS, Burdmann E, Goldstein SL, Herzog C, Joannidis M, Kribben A, Levey AS, MacLeod AM, Mehta RL, Murray PT, Naicker S, Opal SM, Schaefer F, Schetz M, Uchino S (2012) KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Int Suppl 2(1):69–70CrossRef Kellum J, Lameire N, Aspelin P, Barsoum RS, Burdmann E, Goldstein SL, Herzog C, Joannidis M, Kribben A, Levey AS, MacLeod AM, Mehta RL, Murray PT, Naicker S, Opal SM, Schaefer F, Schetz M, Uchino S (2012) KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Int Suppl 2(1):69–70CrossRef
9.
Zurück zum Zitat McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, Mehta A (2016) Contrast-induced acute kidney injury. J Am Coll Cardiol 68(13):1465–1473PubMedCrossRef McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, Mehta A (2016) Contrast-induced acute kidney injury. J Am Coll Cardiol 68(13):1465–1473PubMedCrossRef
10.
Zurück zum Zitat Schachner T, Bonatti J, Bonaros N, Poeltl R, Feuchtner G, Laufer G, Pachinger O, Friedrich G (2006) Risk factors of postoperative nephropathy in patients undergoing innovative CABG and intraoperative graft angiography. Eur J Cardio-thoracic Surg 30(3):431–435CrossRef Schachner T, Bonatti J, Bonaros N, Poeltl R, Feuchtner G, Laufer G, Pachinger O, Friedrich G (2006) Risk factors of postoperative nephropathy in patients undergoing innovative CABG and intraoperative graft angiography. Eur J Cardio-thoracic Surg 30(3):431–435CrossRef
11.
Zurück zum Zitat Thielmann M, Sharma V, Al-Attar N, Bulluck H, Bisleri G, Bunge JJH, Czerny M, Ferdinandy P, Frey UH, Heusch G, Holfeld J, Kleinbongard P, Kunst G, Lang I, Lentini S, Madonna R, Meybohm P, Muneretto C, Obadia JF, Perrino C, Prunier F, Sluijter JPG, Van Laake LW, Sousa-Uva M, Hausenloy DJ (2017) ESC Joint Working Groups on cardiovascular surgery and the cellular biology of the heart position paper: peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J 38(31):2392–2407PubMedPubMedCentralCrossRef Thielmann M, Sharma V, Al-Attar N, Bulluck H, Bisleri G, Bunge JJH, Czerny M, Ferdinandy P, Frey UH, Heusch G, Holfeld J, Kleinbongard P, Kunst G, Lang I, Lentini S, Madonna R, Meybohm P, Muneretto C, Obadia JF, Perrino C, Prunier F, Sluijter JPG, Van Laake LW, Sousa-Uva M, Hausenloy DJ (2017) ESC Joint Working Groups on cardiovascular surgery and the cellular biology of the heart position paper: peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J 38(31):2392–2407PubMedPubMedCentralCrossRef
Metadaten
Titel
Acute kidney injury following coronary artery bypass grafting and control angiography: a comprehensive analysis of 221 patients
verfasst von
Linus Wintgen
Abdul Rahman Dakkak
Mosab Al Shakaki
Konrad Wisniewski
Fausto Biancari
Sven Martens
Andreas Rukosujew
Angelo Maria Dell’Aquila
Publikationsdatum
11.07.2020
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 1/2021
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-020-01655-4

Weitere Artikel der Ausgabe 1/2021

Heart and Vessels 1/2021 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.