TY - JOUR
T1 - Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery
AU - Tecson, Kristen M.
AU - Brown, David
AU - Choi, James W.
AU - Feghali, Georges
AU - Gonzalez-Stawinski, Gonzalo V.
AU - Hamman, Baron L.
AU - Hebeler, Robert
AU - Lander, Stuart R.
AU - Lima, Brian
AU - Potluri, Srini
AU - Schussler, Jeffrey M.
AU - Stoler, Robert C.
AU - Velasco, Carlos
AU - McCullough, Peter A.
N1 - Funding Information:
This work was partially funded by GE Healthcare and the Baylor Health Care System Foundation. Data were provided by the Dallas-Fort Worth Hospital Council Education and Research Foundation, Information Quality Services Center Regional Data (quarter 4, 2015), Irving, Texas.
Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/6
Y1 - 2018/6
N2 - Background: Patients at high risk for having postprocedural complications may receive iodixanol, an iso-osmolar contrast, during coronary angiography to minimize the risk of renal toxicity. For those who also require cardiac surgery, the wait time between angiography and surgery may be a modifiable factor capable of mitigating poor surgical outcomes; however, there have been inconsistent reports regarding the optimal wait time. We sought to determine the effects of wait time between angiography and cardiac surgery, as well as contrast-induced acute kidney injury on the development of major adverse renal and cardiac events (MARCE). Methods: We merged datasets to identify adults who underwent coronary angiography with iodixanol and subsequent cardiac surgery. Results: Of 965 patients, 126 (13.1%) had contrast-induced acute kidney injury; 133 (13.8%) had MARCE within 30 days and 253 (26.2%) within 1 year of surgery. After adjusting for contrast-induced acute kidney injury, age, and Thakar acute renal failure score, the effect of wait time lost significance for the full cohort, but remained for the subgroup of 654 who had coronary artery bypass graft surgery. Patients undergoing coronary artery bypass graft surgery within 1 day of coronary angiography had an approximate twofold increase in risk of MARCE (30-day hazard ratio 2.13, 95% confidence interval: 1.16 to 3.88, p = 0.014; 1-year hazard ratio 2.07, 95% confidence interval: 1.32 to 3.23, p = 0.002) compared with patients who waited 5 or more days. Conclusions: Patients who had contrast-induced acute kidney injury and had cardiac surgery within 1 day of angiography had an increased risk of MARCE.
AB - Background: Patients at high risk for having postprocedural complications may receive iodixanol, an iso-osmolar contrast, during coronary angiography to minimize the risk of renal toxicity. For those who also require cardiac surgery, the wait time between angiography and surgery may be a modifiable factor capable of mitigating poor surgical outcomes; however, there have been inconsistent reports regarding the optimal wait time. We sought to determine the effects of wait time between angiography and cardiac surgery, as well as contrast-induced acute kidney injury on the development of major adverse renal and cardiac events (MARCE). Methods: We merged datasets to identify adults who underwent coronary angiography with iodixanol and subsequent cardiac surgery. Results: Of 965 patients, 126 (13.1%) had contrast-induced acute kidney injury; 133 (13.8%) had MARCE within 30 days and 253 (26.2%) within 1 year of surgery. After adjusting for contrast-induced acute kidney injury, age, and Thakar acute renal failure score, the effect of wait time lost significance for the full cohort, but remained for the subgroup of 654 who had coronary artery bypass graft surgery. Patients undergoing coronary artery bypass graft surgery within 1 day of coronary angiography had an approximate twofold increase in risk of MARCE (30-day hazard ratio 2.13, 95% confidence interval: 1.16 to 3.88, p = 0.014; 1-year hazard ratio 2.07, 95% confidence interval: 1.32 to 3.23, p = 0.002) compared with patients who waited 5 or more days. Conclusions: Patients who had contrast-induced acute kidney injury and had cardiac surgery within 1 day of angiography had an increased risk of MARCE.
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U2 - 10.1016/j.athoracsur.2018.01.010
DO - 10.1016/j.athoracsur.2018.01.010
M3 - Article
C2 - 29408241
AN - SCOPUS:85046779819
SN - 0003-4975
VL - 105
SP - 1724
EP - 1730
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -