Long-term cardiovascular outcomes in patients with chronic kidney disease undergoing coronary artery bypass graft surgery for acute coronary syndromes.

BACKGROUND

Patients with chronic kidney disease have an increased risk of death after myocardial infarction, coronary artery bypass graft surgery (CABG), and percutaneous coronary intervention. We sought to describe the association between chronic kidney disease and long-term cardiovascular outcomes and death in patients who underwent CABG for acute coronary syndromes.

METHODS AND RESULTS

All patients (N=12 956) from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry who underwent CABG for acute coronary syndromes in Sweden between 2000 and 2008 with complete information on preoperative serum creatinine values were included. Estimated glomerular filtration rates (eGFRs) were obtained, and hazard ratios with 95% CIs were calculated for the composite end point of myocardial infarction, heart failure, stroke, or death in relation to eGFR. During a mean follow-up of 3.5 years, there were in total 2844 (22%) cardiovascular events and 1340 (10%) deaths. In patients with eGFR >60 mL/min per 1.73 m(2), 45 to 60 mL/min per 1.73 m(2), and 15 to 45 mL/min per 1.73 m(2), there were 2896 (28%), 882 (43%), and 407 (61%) cardiovascular events or deaths, respectively. Hazard ratios with 95% CIs for death or any cardiovascular event in patients with eGFR 45 to 60 mL/min per 1.73 m(2), and 15 to 45 mL/min per 1.73 m(2) were 1.07 (0.98 to 1.15) and 1.36 (1.22 to 1.53) respectively, after multivariable adjustment. The corresponding figures for any cardiovascular event were 1.08 (0.98 to 1.19), and 1.24 (1.08 to 1.43).

CONCLUSIONS

Severe, but not moderate, renal dysfunction was independently associated with an increased risk of long-term cardiovascular events and death in patients undergoing CABG for acute coronary syndromes.