Risk of acute kidney injury in patients who undergo coronary angiography and cardiac surgery in close succession

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Abstract

AimsCardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast. Methods and resultsWe included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m2, respectively. Cardiac surgery was performed 14 days (range 0235) after coronary angiography. Acute kidney injury occurred in 680 (32) patients per AKI network, 390 (18) patients per RIFLE risk, and 111 (5) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35 of 433 patients operated within 3 days of coronary angiogram vs. 31 of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy. ConclusionRisk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.

Original languageEnglish (US)
Pages (from-to)2065-2070
Number of pages6
JournalEuropean Heart Journal
Volume33
Issue number16
DOIs
StatePublished - Aug 1 2012

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Coronary Angiography
Acute Kidney Injury
Thoracic Surgery
Angiography
Wounds and Injuries
Kidney
United States Department of Veterans Affairs
Cardiopulmonary Bypass
Glomerular Filtration Rate
Creatinine
Diabetes Mellitus
Body Mass Index

Keywords

  • Acute kidney injury
  • Cardiac surgery
  • Coronary angiogram
  • Outcome
  • Surgery complications

Cite this

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title = "Risk of acute kidney injury in patients who undergo coronary angiography and cardiac surgery in close succession",
abstract = "AimsCardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast. Methods and resultsWe included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m2, respectively. Cardiac surgery was performed 14 days (range 0235) after coronary angiography. Acute kidney injury occurred in 680 (32) patients per AKI network, 390 (18) patients per RIFLE risk, and 111 (5) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35 of 433 patients operated within 3 days of coronary angiogram vs. 31 of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy. ConclusionRisk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.",
keywords = "Acute kidney injury, Cardiac surgery, Coronary angiogram, Outcome, Surgery complications",
author = "Byungsoo Ko and Santiago Garcia and Mithani, {Salima A} and Tholakanahalli, {Venkatakrishna N} and Selcuk Adabag",
year = "2012",
month = "8",
day = "1",
doi = "10.1093/eurheartj/ehr493",
language = "English (US)",
volume = "33",
pages = "2065--2070",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "16",

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TY - JOUR

T1 - Risk of acute kidney injury in patients who undergo coronary angiography and cardiac surgery in close succession

AU - Ko, Byungsoo

AU - Garcia, Santiago

AU - Mithani, Salima A

AU - Tholakanahalli, Venkatakrishna N

AU - Adabag, Selcuk

PY - 2012/8/1

Y1 - 2012/8/1

N2 - AimsCardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast. Methods and resultsWe included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m2, respectively. Cardiac surgery was performed 14 days (range 0235) after coronary angiography. Acute kidney injury occurred in 680 (32) patients per AKI network, 390 (18) patients per RIFLE risk, and 111 (5) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35 of 433 patients operated within 3 days of coronary angiogram vs. 31 of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy. ConclusionRisk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.

AB - AimsCardiac surgery and coronary angiography are both associated with risk of acute kidney injury (AKI). We hypothesized that the risk of post-operative AKI increases when coronary angiogram and cardiac surgery are performed in close succession, without sufficient time for recovery from the adverse effects of intravenous contrast. Methods and resultsWe included 2133 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center from 2004 to 2010. Acute kidney injury was defined by the AKI network and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Patients were 66 ± 10 years old. Mean pre-operative creatinine and estimated glomerular filtration rate were 1.1 ± 0.4 mg/dL and 75 ± 22 mL/min/1.73 m2, respectively. Cardiac surgery was performed 14 days (range 0235) after coronary angiography. Acute kidney injury occurred in 680 (32) patients per AKI network, 390 (18) patients per RIFLE risk, and 111 (5) patients per RIFLE injury criteria. Age, body mass index, diabetes mellitus, New York Heart Association class III/IV, cardiopulmonary bypass time, and impaired pre-operative renal function were independent predictors of AKI. However, time between coronary angiogram and cardiac surgery was not a predictor (P = 0.41). AKI occurred in 35 of 433 patients operated within 3 days of coronary angiogram vs. 31 of 1700 patients operated after 3 days (P = 0.17). Results were the same in patients with impaired pre-operative renal function and those with contrast-induced nephropathy. ConclusionRisk of AKI after cardiac surgery is not influenced by the time between coronary angiogram and cardiac surgery. These results do not support the notion of delaying cardiac surgery for the sole purpose of renal recovery after coronary angiogram.

KW - Acute kidney injury

KW - Cardiac surgery

KW - Coronary angiogram

KW - Outcome

KW - Surgery complications

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U2 - 10.1093/eurheartj/ehr493

DO - 10.1093/eurheartj/ehr493

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C2 - 22240498

AN - SCOPUS:84857783740

VL - 33

SP - 2065

EP - 2070

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

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