Kim Kyungmi, Joung Kyoung-Woon, Ji Sung-Mi, Kim Ji-Yoon, Lee Eun-Ho, Chung Cheol-Hyun, Choi In-Cheol
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University, Cheonan, Korea.
J Thorac Cardiovasc Surg. 2016 Jul;152(1):254-261.e3. doi: 10.1016/j.jtcvs.2016.02.063. Epub 2016 Mar 12.
Acute kidney injury is a common but serious complication of coronary artery bypass grafting. We investigated whether the effect of the timing of coronary angiography on acute kidney injury after coronary artery bypass grafting is influenced by the use of cardiopulmonary bypass.
We included, retrospectively, 2371 patients who underwent coronary artery bypass grafting whether cardiopulmonary bypass was used (on-pump coronary artery bypass) or not (off-pump coronary artery bypass). Postoperative acute kidney injury was defined by the consensus Kidney Disease: Improving Global Outcomes Definition and Staging criteria. Multivariate logistic regression and propensity score analysis were performed to evaluate the association of the time interval between coronary angiography and coronary artery bypass grafting with postoperative acute kidney injury.
The incidence of acute kidney injury was higher in patients who underwent coronary angiography 7 days or less before coronary artery bypass grafting than in those who underwent it more than 7 days before coronary artery bypass grafting (42.7% vs 38.5%, P = .037). There was significant interaction between the timing of coronary angiography and the use of cardiopulmonary bypass for postoperative acute kidney injury (P = .019). The time interval between coronary angiography and surgery was independently associated with postoperative acute kidney injury in patients undergoing on-pump coronary artery bypass only. In an adjusted propensity score model, coronary angiography within 7 days of on-pump coronary artery bypass was a predictor of postoperative acute kidney injury (odds ratio, 1.742; 95% confidence interval, 1.144-2.653; P = .010).
A shorter interval between coronary angiography and surgery influenced the occurrence of acute kidney injury in patients undergoing on-pump coronary artery bypass. However, the interval is not an independent risk factor for the development of postoperative acute kidney injury in patients who undergo off-pump coronary artery bypass.
急性肾损伤是冠状动脉搭桥术常见但严重的并发症。我们研究了冠状动脉造影时间对冠状动脉搭桥术后急性肾损伤的影响是否受体外循环使用情况的影响。
我们回顾性纳入了2371例行冠状动脉搭桥术的患者，无论是否使用体外循环（体外循环冠状动脉搭桥术或非体外循环冠状动脉搭桥术）。术后急性肾损伤根据《肾脏病：改善全球预后》定义和分期标准的共识进行定义。进行多因素逻辑回归和倾向评分分析，以评估冠状动脉造影与冠状动脉搭桥术之间的时间间隔与术后急性肾损伤的相关性。
冠状动脉搭桥术前7天内进行冠状动脉造影的患者急性肾损伤发生率高于冠状动脉搭桥术前7天以上进行冠状动脉造影的患者（42.7%对38.5%，P = 0.037）。冠状动脉造影时间与体外循环使用情况对术后急性肾损伤有显著交互作用（P = 0.019）。冠状动脉造影与手术之间的时间间隔仅在接受体外循环冠状动脉搭桥术的患者中与术后急性肾损伤独立相关。在调整后的倾向评分模型中，体外循环冠状动脉搭桥术7天内进行冠状动脉造影是术后急性肾损伤的预测因素（比值比，1.742；95%置信区间，1.144 - 2.653；P = 0.010）。
冠状动脉造影与手术之间较短的时间间隔影响体外循环冠状动脉搭桥术患者急性肾损伤的发生。然而，该时间间隔并非非体外循环冠状动脉搭桥术患者术后急性肾损伤发生的独立危险因素。
