Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery

Kristen M. Tecson, David Brown, James W. Choi, Georges Feghali, Gonzalo V. Gonzalez-Stawinski, Baron L. Hamman, Robert Hebeler, Stuart R. Lander, Brian Lima, Srini Potluri, Jeffrey M. Schussler, Robert C. Stoler, Carlos Velasco, Peter A. McCullough

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1724-1730
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Coronary Angiography
Acute Kidney Injury
Thoracic Surgery
Kidney
Angiography
Coronary Artery Bypass
Confidence Intervals
Transplants
iodixanol

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Tecson, K. M., Brown, D., Choi, J. W., Feghali, G., Gonzalez-Stawinski, G. V., Hamman, B. L., ... McCullough, P. A. (2018). Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. Annals of Thoracic Surgery, 105(6), 1724-1730. https://doi.org/10.1016/j.athoracsur.2018.01.010

Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. / Tecson, Kristen M.; Brown, David; Choi, James W.; Feghali, Georges; Gonzalez-Stawinski, Gonzalo V.; Hamman, Baron L.; Hebeler, Robert; Lander, Stuart R.; Lima, Brian; Potluri, Srini; Schussler, Jeffrey M.; Stoler, Robert C.; Velasco, Carlos; McCullough, Peter A.

In: Annals of Thoracic Surgery, Vol. 105, No. 6, 01.06.2018, p. 1724-1730.

Research output: Contribution to journalArticle

Tecson, KM, Brown, D, Choi, JW, Feghali, G, Gonzalez-Stawinski, GV, Hamman, BL, Hebeler, R, Lander, SR, Lima, B, Potluri, S, Schussler, JM, Stoler, RC, Velasco, C & McCullough, PA 2018, 'Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery', Annals of Thoracic Surgery, vol. 105, no. 6, pp. 1724-1730. https://doi.org/10.1016/j.athoracsur.2018.01.010
Tecson KM, Brown D, Choi JW, Feghali G, Gonzalez-Stawinski GV, Hamman BL et al. Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. Annals of Thoracic Surgery. 2018 Jun 1;105(6):1724-1730. https://doi.org/10.1016/j.athoracsur.2018.01.010
Tecson, Kristen M. ; Brown, David ; Choi, James W. ; Feghali, Georges ; Gonzalez-Stawinski, Gonzalo V. ; Hamman, Baron L. ; Hebeler, Robert ; Lander, Stuart R. ; Lima, Brian ; Potluri, Srini ; Schussler, Jeffrey M. ; Stoler, Robert C. ; Velasco, Carlos ; McCullough, Peter A. / Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 6. pp. 1724-1730.
@article{54bdd0ed79344f3e9450fdc1de0cc360,
title = "Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery",
abstract = "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.",
author = "Tecson, {Kristen M.} and David Brown and Choi, {James W.} and Georges Feghali and Gonzalez-Stawinski, {Gonzalo V.} and Hamman, {Baron L.} and Robert Hebeler and Lander, {Stuart R.} and Brian Lima and Srini Potluri and Schussler, {Jeffrey M.} and Stoler, {Robert C.} and Carlos Velasco and McCullough, {Peter A.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.athoracsur.2018.01.010",
language = "English (US)",
volume = "105",
pages = "1724--1730",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

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.

PY - 2018/6/1

Y1 - 2018/6/1

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.

UR - http://www.scopus.com/inward/record.url?scp=85046779819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046779819&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2018.01.010

DO - 10.1016/j.athoracsur.2018.01.010

M3 - Article

C2 - 29408241

AN - SCOPUS:85046779819

VL - 105

SP - 1724

EP - 1730

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -