Incidence, determinants and impact of acute kidney injury in patients with diabetes mellitus and multivessel disease undergoing coronary revascularization: Results from the FREEDOM trial

Autor: Yaron Arbel, Valentin Fuster, Flora S. Siami, Taye H. Hamza, Usman Baber, Michael E. Farkouh
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Comorbidity
Coronary Artery Disease
030204 cardiovascular system & hematology
urologic and male genital diseases
Revascularization
Severity of Illness Index
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
medicine
Clinical endpoint
Diabetes Mellitus
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
Correlation of Data
Stroke
business.industry
Incidence
Percutaneous coronary intervention
Acute Kidney Injury
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
Conventional PCI
Cardiology
Female
Risk Adjustment
Cardiology and Cardiovascular Medicine
business
Mace
Zdroj: International journal of cardiology. 293
ISSN: 1874-1754
Popis: The incidence and prognostic significance of acute kidney injury (AKI) in patients with diabetes mellitus and multivessel coronary artery disease undergoing coronary revascularization is not well known. The current analysis included patients randomized to PCI vs. CABG as part of the FREEDOM trial. We sought to examine the impact of AKI and its predictors in diabetic patients with multivessel coronary artery disease undergoing PCI vs. CABG.We conducted a pre-specified subgroup analysis of the FREEDOM trial to examine the incidence, correlates and impact of AKI according to revascularization strategy. AKI predictors were identified using multivariable logistic regression and associations between AKI and outcomes were examined using Cox regression. The primary endpoint was the composite occurrence of all-cause death, stroke or myocardial infarction at 5 years of follow-up.KI occurred more frequently in patients following CABG (15.6%) compared with PCI (9.1%) (p 0.001). AKI was associated with a higher risk for major cardiovascular events (MACE) at 5 years (34.6% vs. 20.5%, p 0.001), an effect that remained large and significant irrespective of CABG (HR = 2.18 95% CI 1.44-3.31, p ≤0.001) or PCI (HR = 2.08 95% CI 1.35-3.21, p 0.0001). There was a non-significant interaction (p-value = 0.89) between the revascularization method and AKI, supporting that AKI is a significant risk factor in both revascularization methods.Although risk for AKI was higher in patients undergoing CABG, the impact of AKI on MACE was substantial irrespective of revascularization strategy. Preventive strategies to identify patients at risk for AKI are warranted to mitigate the long-term effects of this complication.
Databáze: OpenAIRE
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