Impact of renal function impairment assessed by CKDEPI estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting
| Autor: | Sabina Caciolli, Francesco Matteucci, G. A. Fradella, Niccolò Marchionni, Massimo Bonacchi, Orlando Parise, Sandro Gelsomino, Simona Fusco, Stefano Del Pace, Fabiana Lucà |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry medicine.medical_treatment Hazard ratio Renal function 030204 cardiovascular system & hematology medicine.disease Cardiac surgery 03 medical and health sciences 0302 clinical medicine Internal medicine Heart failure medicine Cardiology 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine business Stroke Dialysis |
| Zdroj: | International Journal of Cardiology. 227:778-787 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2016.10.059 |
| Popis: | Background We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFR CKD-EPI ). We also try to identify cut-off values of eGFR CKD-EPI able to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary. Methods One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFR CKD-EPI : Group 1 (≥60ml/min/1.73m 2 ; n=1199), Group 2 (45–59ml/min/1.73m 2 ; n=358), Group 3 (30–44ml/min/1.73m 2 ; n=171) and Group 4 (≤29ml/min/1.73m 2 ; n=126). Median follow-up was 66months [IQR 46–84]. Results eGFR CKD-EPI ≤30ml/min/1.73m 2 , ≤41ml/min/1.73m 2 , ≤27ml/min/1.73m 2 and ≤29ml/min/1.73m 2 were strong predictors of early mortality (OR 5.88 [95% CI 2.59–11.25]), stroke (2.59 [1.43–3.71]), prolonged length of stay (3.49 [1.24–5.92]) and postoperative dialysis (3.68 [1.34–4.91]), respectively. In addition, eGFR CKD-EPI ≤26ml/min/1.73m 2 , ≤25ml/min/1.73m 2 , ≤35ml/min/1.73m 2 and ≤29ml/min/1.73m 2 predicted all-cause death (hazard ratio 2.74 [95% CI 2.10–3.92] cardiovascular death (sub-hazard ratio 2.11 [95% CI 1.42–3.90]), myocardial infarction (2.01 [1.32–3.70]) and heart failure (2.24 [1.41–3.93]), respectively. Analyses corrected by age and left ventricular ejection fraction confirmed these findings. Conclusions In our experience, the use of the eGFR CKD-EPI equation led to categorization with a significantly lower number of patients at risk for post-CABG complications. This might have important clinical repercussions on allocation of healthcare resources and more targeted prevention and management of CABG complications. |
| Databáze: | OpenAIRE |
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