Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China; The Shanghai East Clinical Medical College of Nanjing Medical University, Shanghai, P. R. China.
Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China.
Heart Lung Circ. 2021 Feb;30(2):288-295. doi: 10.1016/j.hlc.2020.05.105. Epub 2020 Jun 24.
Renal dysfunction is independently associated with increased early and late mortality after coronary artery bypass graft (CABG) surgery. Off-pump CABG (OPCABG) avoids postoperative complications from the cardiopulmonary bypass, but it is unclear how it is impacted by occult renal dysfunction (ORD). This study aimed to investigate the effects of ORD on early and late outcomes after OPCABG.
This retrospective and observational cohort study reviewed data on 1,188 patients who underwent first isolated OPCABG with normal serum creatinine (SCr) levels. According to preoperative estimated creatinine clearance (eCrCl) by the Cockcroft-Gault formula, the patients were divided into an ORD group (n=260, eCrCl <60 mL/min/1.73 m) and a control group (n=928, eCrCl ≥60 mL/min/1.73 m).
The ORD patients presented with older age, higher incidence of small body surface area, hypertension, low preoperative eCrCl, cerebrovascular accident, peripheral vascular disease, New York Heart Association (NYHA) Ⅲ, and high risk score. The prevalence of hospital mortality, postoperative acute kidney injury (AKI), peak postoperative SCr, and prolonged hospital stay were greater in the ORD patients than the control patients. Multivariable logistic regression analysis showed that the ORD patients were at significantly higher risk of postoperative AKI (OR, 2.702; 95% CI, 1.994-3.662) and in-hospital mortality (OR, 2.884; 95% CI, 1.293-6.432). Multivariate Cox proportional hazard models confirmed that ORD was significantly associated with high later mortality (HR, 2.847; 95% CI, 1.262-6.425).
Occult renal dysfunction is an independent risk factor for postoperative AKI in-hospital and later mortality in patients undergoing OPCABG with normal SCr levels.
肾功能障碍与冠状动脉旁路移植术（CABG）后早期和晚期死亡率的增加独立相关。非体外循环冠状动脉旁路移植术（OPCABG）避免了体外循环术后的并发症，但尚不清楚它是如何受到隐匿性肾功能障碍（ORD）的影响。本研究旨在探讨 ORD 对 OPCABG 术后早期和晚期结果的影响。
这是一项回顾性观察队列研究，对 1188 名接受首次单纯 OPCABG 且血清肌酐（SCr）水平正常的患者进行了数据分析。根据 Cockcroft-Gault 公式估算的术前肌酐清除率（eCrCl），患者分为 ORD 组（n=260，eCrCl <60 mL/min/1.73 m）和对照组（n=928，eCrCl ≥60 mL/min/1.73 m）。
ORD 组患者年龄较大，小体型表面积发生率较高，合并高血压、术前 eCrCl 较低、脑血管意外、外周血管疾病、纽约心脏协会（NYHA）Ⅲ级和高风险评分。与对照组相比，ORD 组患者的住院死亡率、术后急性肾损伤（AKI）、术后 SCr 峰值和住院时间延长的发生率更高。多变量逻辑回归分析显示，与对照组相比，ORD 组患者术后 AKI（OR，2.702；95%CI，1.994-3.662）和住院内死亡率（OR，2.884；95%CI，1.293-6.432）的风险显著增加。多变量 Cox 比例风险模型证实，ORD 与较高的晚期死亡率显著相关（HR，2.847；95%CI，1.262-6.425）。
在 SCr 水平正常的 OPCABG 患者中，隐匿性肾功能障碍是术后 AKI 和住院后死亡的独立危险因素。
