Shen Wen, Aguilar Rodrigo, Montero Alex R, Fernandez Stephen J, Taylor Allen J, Wilcox Christopher S, Lipkowitz Michael S, Umans Jason G
Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC, USA.
Am J Nephrol. 2017;45(3):217-225. doi: 10.1159/000455906. Epub 2017 Jan 31.
Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent.
We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups.
The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges.
Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.
术后急性肾损伤（AKI）与短期和长期死亡率以及肾丢失的显著增加相关。很少有研究比较两种主要血运重建方式——冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）——术后AKI的发生率和院内死亡率，结果并不一致。
我们从国家住院患者样本数据库中生成了一个倾向评分匹配队列，其中包括2004年至2012年期间共286,670例接受CABG或PCI治疗的多支冠状动脉疾病住院患者。我们比较了CABG组和PCI组之间AKI的发生率、需要肾脏替代治疗（RRT）的AKI发生率、院内死亡率、住院时间和费用。
CABG术后AKI的发生率高于PCI（8.9%对4.5%，OR 2.05，95%CI 1.99 - 2.12，p < 0.001）。CABG术后需要RRT的AKI发生率也更高（1.1%对0.5%，OR 2.14，95%CI 1.96 - 2.34，p < 0.001）。同样，CABG术后的院内死亡率高于PCI（2.0%对1.4%，OR 1.44，95%CI 1.35 - 1.52，p < 0.001）。在已有慢性肾脏病（I - IV期）的患者中，接受CABG的患者发生AKI的几率比接受PCI的患者高2.0至2.3倍。接受CABG治疗的患者住院时间明显更长，住院费用更高。
接受CABG治疗的患者存在以下情况：（1）术后发生AKI的风险增加；（2）接受RRT的可能性更高；（3）短期生存率更差。长期肾脏结局仍有待研究。
