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Am Heart J. 2016 Jan;171(1):40-7. doi: 10.1016/j.ahj.2015.07.001. Epub 2015 Jul 8.

Incidence and impact of acute kidney injury in patients with acute coronary syndromes treated with coronary artery bypass grafting: Insights from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials.

Author information

  • 1Icahn School of Medicine at Mount Sinai, New York, NY.
  • 2Icahn School of Medicine at Mount Sinai, New York, NY; Cardiovascular Research Foundation, New York, NY. Electronic address: roxana.mehran@mountsinai.org.
  • 3Cardiovascular Research Foundation, New York, NY.
  • 4Mayo Clinic College of Medicine, Rochester, MN.
  • 5Ospedale Papa Giovanni XXIII, Bergamo, Italy.
  • 6Helios Amper-Klinikum, Dachau, Germany.
  • 7Duke University Medical Center, Durham, NC.
  • 8Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • 9Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY.

Abstract

BACKGROUND:

Acute kidney injury (AKI) is a well-recognized predictor of morbidity and mortality after percutaneous coronary intervention. However, the impact of AKI on the outcome of patients with acute coronary syndromes (ACS) in relation to coronary artery bypass grafting (CABG) has not been established.

METHODS:

Of the 17,421 patients who presented with non-ST-segment elevation ACS or ST-segment elevation myocardial infarction enrolled in the ACUITY and HORIZONS-AMI trials, 1,406 (8.0%) underwent CABG as principal treatment after coronary angiography. End points were measured at 1 month and 1 year and included death, myocardial infarction, and ischemia-driven target vessel revascularization. Acute kidney injury was defined as a rise in creatinine of ≥ 0.5 mg/dL, or > 25%, from baseline at initial angiography.

RESULTS:

Acute kidney injury occurred during hospital admission in 449 (31.9%) of the 1,406 patients treated with CABG. One-month and 1-year mortality was 6.7% vs 2.2% (P < .0001) and 10.4% vs 4.3% (P < .0001) for patients with vs without AKI, respectively. Analogously, the 1-month and 1-year incidence of composite major adverse cardiac events (MACEs; death, MI, or target vessel revascularization) was 17.6% vs 12.4% (P = .003) and 22.0% vs 15.3% (P = .002) for patients with vs without AKI, respectively. After adjustment for age, sex, race, diabetes, hypertension, and baseline creatinine clearance, AKI was an independent predictor of mortality (overall and cardiac-related) and MACE at both 1 month and 1 year in patients treated with CABG.

CONCLUSIONS:

Acute kidney injury occurred in approximately 1 of every 3 patients with ACS treated with CABG and is a powerful independent predictor of death and MACE. These data highlight the need for AKI prevention strategies in patients undergoing CABG.

Copyright © 2015. Published by Elsevier Inc.

PMID:
26699599
[PubMed - indexed for MEDLINE]
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