Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
Department of Blood Purification, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Gen Thorac Cardiovasc Surg. 2021 Nov;69(11):1445-1452. doi: 10.1007/s11748-021-01602-8. Epub 2021 Feb 6.
Cardiac surgery and contrast media are both related to acute kidney injury. We investigated whether undergoing coronary computed tomography angiography, which uses less contrast medium, before on-pump cardiac surgery could reduce the risk of postoperative acute kidney injury compared to coronary angiography.
In this retrospective study, 745 and 171 patients underwent coronary angiography and coronary computed tomography angiography, respectively, within 30 days before on-pump cardiac surgery. Postoperative acute kidney injury was defined according to Kidney Disease Improving Global Outcomes Definition and Staging criteria.
Age, hypertension, cardiopulmonary bypass time, and performing cardiac surgery within 24 h of preoperative angiography (odds ratio: 1.507, 95% confidence interval: 1.111‒2.045, P = 0.008) independently predicted postoperative acute kidney injury on multivariable analysis. After propensity score matching, the acute kidney injury incidence in coronary angiography and computed tomography angiography groups was 43% and 46%, respectively (P = 0.65), and the groups had similar intensive care unit stay (2 days vs. 2 days, P = 0.209), postoperative hospital stay (11 days vs. 12 days, P = 0.084), postoperative continuous renal replacement therapy use (0.6% vs 1.9%, P = 0.314), and in-hospital mortality (0 vs. 1.3%, P = 0.156). In-hospital outcomes were similar among patients who underwent preoperative coronary angiography or computed tomography angiography within 24 h before cardiac surgery.
Although coronary computed tomography angiography uses less contrast medium, it does not reduce the risk of postoperative acute kidney injury or improve in-hospital outcomes compared to coronary angiography.
心脏手术和造影剂均与急性肾损伤有关。我们研究了在体外循环心脏手术前进行使用造影剂较少的冠状动脉计算机断层扫描血管造影术（coronary computed tomography angiography，CCTA）是否比冠状动脉造影术（coronary angiography，CAG）降低术后急性肾损伤的风险。
在这项回顾性研究中，745 例患者在体外循环心脏手术前 30 天内行 CAG，171 例患者行 CCTA。术后急性肾损伤根据肾脏病改善全球结局（Kidney Disease Improving Global Outcomes，KDIGO）定义和分期标准进行定义。
多变量分析显示，年龄、高血压、体外循环时间以及术前血管造影后 24 小时内行心脏手术（比值比：1.507，95%置信区间：1.111‒2.045，P=0.008）是术后急性肾损伤的独立预测因素。在进行倾向评分匹配后，CAG 和 CCTA 组的急性肾损伤发生率分别为 43%和 46%（P=0.65），两组的重症监护病房（intensive care unit，ICU）入住时间（2 天 vs. 2 天，P=0.209）、术后住院时间（11 天 vs. 12 天，P=0.084）、术后连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）使用率（0.6% vs. 1.9%，P=0.314）和院内死亡率（0 与 1.3%，P=0.156）相似。术前 24 小时内行 CAG 或 CCTA 的患者的院内结局相似。
尽管 CCTA 使用的造影剂较少，但与 CAG 相比，其并不能降低术后急性肾损伤的风险或改善院内结局。
