Impact of timing of urgent coronary artery bypass grafting following coronary angiography on acute kidney injury

Brandon S Peine; Yuanyuan Fu; SaeRam Oh; Seth Quinn; J Preston Bethea; O Jesse Mendes; Linda Kindell; William Irish; Shahab A Akhter

doi:10.1016/j.jtcvs.2023.05.042

Impact of timing of urgent coronary artery bypass grafting following coronary angiography on acute kidney injury

J Thorac Cardiovasc Surg. 2023 Jun 24:S0022-5223(23)00531-7. doi: 10.1016/j.jtcvs.2023.05.042. Online ahead of print.

Authors

Brandon S Peine¹, Yuanyuan Fu², SaeRam Oh³, Seth Quinn³, J Preston Bethea³, O Jesse Mendes³, Linda Kindell⁴, William Irish², Shahab A Akhter⁴

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC. Electronic address: peineb19@ecu.edu.
² Division of Surgical Research, Department of Surgery, East Carolina University, Greenville, NC.
³ Division of General Surgery, Department of Surgery, East Carolina University, Greenville, NC.
⁴ Division of Cardiac Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.

PMID: 37356474
DOI: 10.1016/j.jtcvs.2023.05.042

Abstract

Objectives: Prior studies have examined the association between timing of cardiac surgery after coronary angiography with risk of acute kidney injury, but this remains controversial. The purpose of this study was to investigate the association between interval from coronary angiography to urgent coronary artery bypass grafting with acute kidney injury, and to examine this possible effect in patients with preexisting kidney disease.

Methods: Patients from a single institution undergoing urgent, isolated coronary artery bypass grafting within 7 days of coronary angiography were included. Patients were subdivided by chronic kidney disease stage and angiography-to-surgery interval. Locally estimated scatterplot smoothing was used to evaluate the functional relationship of the probability of acute kidney injury and time interval. Adjusted odds ratios were calculated for each time interval group compared against the Day 0 to 1 interval group, controlling for multiple covariates. Analyses were repeated for each chronic kidney disease subgroup.

Results: A total of 2249 patients were included in this study. There were 271 (12.0%) patients with postoperative acute kidney injury. Plots demonstrated a decreasing risk of kidney injury from Day 0 to 1 to Day 3 following coronary angiography. Adjusted odds ratios also showed a significant decrease in risk of kidney injury on Day 3 compared with Day 0 to 1. Analyses repeated for each chronic kidney disease stage showed similar trends.

Conclusions: For patients undergoing urgent coronary artery bypass grafting, there is a decreased risk of kidney injury in those having surgery on day 3 after coronary angiography compared with those having surgery on Day 0 to 1, regardless of preexisting kidney disease.

Keywords: acute kidney injury; chronic kidney disease; coronary angiography; coronary artery bypass grafting; dialysis.