Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery. VA Cooperative Study #5

Kidney Int. 1999 Mar;55(3):1057-62. doi: 10.1046/j.1523-1755.1999.0550031057.x.

Abstract

Background: More than 600,000 coronary artery bypass graft (CABG) procedures are done annually in the United States. Some data indicate that 10 to 20% of patients who are undergoing a CABG procedure have a serum creatinine of more than 1.5 mg/dl. There are few data on the impact of a mild increase in serum creatinine concentration on CABG outcome.

Methods: We analyzed a Veterans Affairs database obtained prospectively from 1992 through 1996 at 14 of 43 centers performing heart surgery. We compared the outcome after CABG in patients with a baseline serum creatinine of less than 1.5 mg/dl (median 1.1 mg/dl, N = 3271) to patients with a baseline serum creatinine of 1.5 to 3.0 mg/dl (median 1.7, N = 631).

Results: Univariate analysis revealed that patients with a serum creatinine of 1.5 to 3.0 mg/dl had a higher 30-day mortality (7% vs. 3%, P < 0.001) requirement for prolonged mechanical ventilation (15% vs. 8%, P = 0.001), stroke (7% vs. 2%, P < 0.001), renal failure requiring dialysis at discharge (3% vs. 1%, P < 0.001), and bleeding complications (8% vs. 3%, P < 0.001) than patients with a baseline serum creatinine of less than 1.5 mg/dl. Multiple logistic regression analyses found that patients with a baseline serum creatinine of less than 1.5 mg/dl had significantly lower (P < 0.02) 30-day mortality and postoperative bleeding and ventilatory complications than patients with a serum creatinine of 1.5 to 3.0 mg/dl when controlling for all other variables.

Conclusion: These results demonstrate that mild renal failure is an independent risk factor for adverse outcome after CABG.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Bypass / mortality
  • Creatinine / blood
  • Databases, Factual
  • Female
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications*
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Prospective Studies
  • Respiratory Tract Diseases / etiology
  • Risk Factors
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Creatinine