Relation between Preoperative Mild Increased in Serum Creatinine Level and Early Outcomes after Coronary Artery Bypass Grafting

  • Hassan Radmehr Cardiovascular Surgery Department, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Khalil Forouzannia Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi University of Medical Sciences, Yazd, Iran.
  • Ali Reza Bakhshandeh Cardiovascular Surgery Department, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Mehdi Sanatkar Cardiovascular Surgery Department, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Serum creatinine, Coronary artery bypass graft surgery, Early mortality

Abstract

This study evaluates the effect of preoperative increased level of serum creatinine (Cr) on early outcomes after coronary artery bypass graft surgery (CABG). 1140 patients who underwent CABG in our center were studied. Patients with Cr >2.25 mg/dl or preoperative dialysis and who had off-pump operations were excluded. Group 1 consisted of 892 patients with normal Cr (0.5-1.2 mg/dl) and group 2 consisted of 248 (21.8%) patients with mild increased level of serum Cr (1.3-2.2 mg/dl). Patients in group 1 were younger than group 2. There were more patients with hypertension in group 2, but there were not statistically significant difference between two groups in terms of the frequency of diabetes, smoking, cerebrovascular disease and New York Heart Association (NYHA) class. Left ventricular ejection fraction (LVEF) was lower in group 2. Cardiopulmonary bypass time (CPB) was longer in group 2. Early mortality was 3.2% in group 1 and 8.4% in group 2 (P

References

Devbhandari MP, Duncan AJ, Grayson AD, Fabri BM, Keenan DJ, Bridgewater B, Jones MT, Au J; North West Quality Improvement Programme in Cardiac Interventions. Effect of risk-adjusted, nondialysis- dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multi-centre study. Eur J Cardiothorac Surg 2006;29(6):964-70.

Hirose H, Amano A, Takahashi A, Nagano N. Coronary artery bypass grafting for patients with non-dialysisdependent renal dysfunction (serum creatinine > or =2.0 mg/dl). Eur J Cardiothorac Surg 2001;20(3):565-72.

Lok CE, Austin PC, Wang H, Tu JV. Impact of renal insufficiency on short- and long-term outcomes after cardiac surgery. Am Heart J 2004;148(3):430-8.

Dacey LJ, Liu JY, Braxton JH, Weintraub RM, DeSimone J, Charlesworth DC, Lahey SJ, Ross CS, Hernandez F Jr, Leavitt BJ, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 2002;74(2):458-62.

Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004;15(6):1597-605.

Brown JR, Cochran RP, Dacey LJ, Ross CS, Kunzelman KS, Dunton RF, Braxton JH, Charlesworth DC, Clough RA, Helm RE, Leavitt BJ, MacKenzie TA, O'Connor GT. Northern New England Cardiovascular Disease Study Group. Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery. Circulation 2006;114(1 Suppl):I409-13.

Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G, Stegeman CA. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005;16(1):195-200.

Provenchère S, Plantefève G, Hufnagel G, Vicaut E, De Vaumas C, Lecharny JB, Depoix JP, Vrtovsnik F, Desmonts JM, Philip I. Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome. Anesth Analg 2003;96(5):1258-64.

Jyralaa A, Weissb RE, Jeffriesb RA, Kaya GL. Effect of mild renal dysfunction (s-crea 1.2–2.2 mg/dl) on presentation characteristics and short- and long-term outcomes of on-pump cardiac surgery patients. Interact CardioVasc Thorac Surg 2010;10:777-82.

Simon C, Luciani R, Capuano F, Miceli A, Roscitano A, Tonelli E, Sinatra R. Mild and moderate renal dysfunction: impact on short-term outcome. Eur J Cardiothorac Surg 2007;32(2):286-90.

Zakeri R, Freemantle N, Barnett V, Lipkin GW, Bonser RS, Graham TR, Rooney SJ, Wilson IC, Cramb R, Keogh BE, Pagano D. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation 2005;112(9 Suppl):I270-5.

Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Carpentier A, Adams DH. Early and late outcomes of cardiac surgery in patients with moderate to severe preoperative renal dysfunction without dialysis. Interact Cardiovasc Thorac Surg 2008;7(1):90-5.

Cooper WA, O'Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, Petersen R, Peterson ED. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006;113(8):1063-70.

Howell NJ, Keogh BE, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Pagano D. Mild renal dysfunction predicts in-hospital mortality and postdischarge survival following cardiac surgery. Eur J Cardiothorac Surg 2008;34(2):390-5.

Weerasinghe A, Hornick P, Smith P, Taylor K, Ratnatunga C. Coronary artery bypass grafting in non-dialysisdependent mild-to-moderate renal dysfunction. J Thorac Cardiovasc Surg 2001;121(6):1083-9.

Zanardo G, Michielon P, Paccagnella A, Rosi P, Caló M, Salandin V, Da Ros A, Michieletto F, Simini G. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994;107(6):1489-95.

Stafford-Smith M, Reddan DN, Phillips-Bute B, Newman MF, Winn MP. Association of perioperative creatininederived variables with mortality and other outcomes after coronary bypass surgery. Anesth Analg 2001;92(Suppl):SCA28.

Kilo J, Margreiter JE, Ruttmann E, Laufer G, Bonatti JO. Slightly elevated serum creatinine predicts renal failure requiring hemofiltration after cardiac surgery. Heart Surg Forum 2005;8(1):E34-8.

How to Cite
1.
Radmehr H, Forouzannia SK, Bakhshandeh AR, Sanatkar M. Relation between Preoperative Mild Increased in Serum Creatinine Level and Early Outcomes after Coronary Artery Bypass Grafting. Acta Med Iran. 49(2):89-92.
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