We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFRCKD-EPI). We also try to identify cut-off values of eGFRCKD-EPI able to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary. Methods One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFRCKD-EPI: Group 1 (≥ 60 ml/min/1.73 m2; n = 1199), Group 2 (45–59 ml/min/1.73 m2; n = 358), Group 3 (30–44 ml/min/1.73 m2; n = 171) and Group 4 (≤ 29 ml/min/1.73 m2; n = 126). Median follow-up was 66 months [IQR 46–84]. Results eGFRCKD-EPI ≤ 30 ml/min/1.73 m2, ≤ 41 ml/min/1.73 m2, ≤ 27 ml/min/1.73 m2 and ≤ 29 ml/min/1.73 m2 were strong predictors of early mortality (OR 5.88 [95% CI 2.59–11.25]), stroke (2.59 [1.43–3.71]), prolonged length of stay (3.49 [1.24–5.92]) and postoperative dialysis (3.68 [1.34–4.91]), respectively. In addition, eGFRCKD-EPI ≤ 26 ml/min/1.73 m2, ≤ 25 ml/min/1.73 m2, ≤ 35 ml/min/1.73 m2 and ≤ 29 ml/min/1.73 m2 predicted all-cause death (hazard ratio 2.74 [95% CI 2.10–3.92] cardiovascular death (sub-hazard ratio 2.11 [95% CI 1.42–3.90]), myocardial infarction (2.01 [1.32–3.70]) and heart failure (2.24 [1.41–3.93]), respectively. Analyses corrected by age and left ventricular ejection fraction confirmed these findings. Conclusions In our experience, the use of the eGFRCKD-EPI equation led to categorization with a significantly lower number of patients at risk for post-CABG complications. This might have important clinical repercussions on allocation of healthcare resources and more targeted prevention and management of CABG complications.

Impact of renal function impairment assessed by CKDEPI estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting / Gelsomino, Sandro; Del Pace, Stefano; Parise, Orlando; Caciolli, Sabina; Matteucci, Francesco; Fradella, Giuseppe; Bonacchi, Massimo; Fusco, Simona; Lucà, Fabiana; Marchionni, Niccoló. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - STAMPA. - 227:(2017), pp. 778-787. [10.1016/j.ijcard.2016.10.059]

Impact of renal function impairment assessed by CKDEPI estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting

BONACCHI, MASSIMO
;
Marchionni, Niccoló
2017

Abstract

We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFRCKD-EPI). We also try to identify cut-off values of eGFRCKD-EPI able to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary. Methods One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFRCKD-EPI: Group 1 (≥ 60 ml/min/1.73 m2; n = 1199), Group 2 (45–59 ml/min/1.73 m2; n = 358), Group 3 (30–44 ml/min/1.73 m2; n = 171) and Group 4 (≤ 29 ml/min/1.73 m2; n = 126). Median follow-up was 66 months [IQR 46–84]. Results eGFRCKD-EPI ≤ 30 ml/min/1.73 m2, ≤ 41 ml/min/1.73 m2, ≤ 27 ml/min/1.73 m2 and ≤ 29 ml/min/1.73 m2 were strong predictors of early mortality (OR 5.88 [95% CI 2.59–11.25]), stroke (2.59 [1.43–3.71]), prolonged length of stay (3.49 [1.24–5.92]) and postoperative dialysis (3.68 [1.34–4.91]), respectively. In addition, eGFRCKD-EPI ≤ 26 ml/min/1.73 m2, ≤ 25 ml/min/1.73 m2, ≤ 35 ml/min/1.73 m2 and ≤ 29 ml/min/1.73 m2 predicted all-cause death (hazard ratio 2.74 [95% CI 2.10–3.92] cardiovascular death (sub-hazard ratio 2.11 [95% CI 1.42–3.90]), myocardial infarction (2.01 [1.32–3.70]) and heart failure (2.24 [1.41–3.93]), respectively. Analyses corrected by age and left ventricular ejection fraction confirmed these findings. Conclusions In our experience, the use of the eGFRCKD-EPI equation led to categorization with a significantly lower number of patients at risk for post-CABG complications. This might have important clinical repercussions on allocation of healthcare resources and more targeted prevention and management of CABG complications.
2017
227
778
787
Gelsomino, Sandro; Del Pace, Stefano; Parise, Orlando; Caciolli, Sabina; Matteucci, Francesco; Fradella, Giuseppe; Bonacchi, Massimo; Fusco, Simona; Lucà, Fabiana; Marchionni, Niccoló
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1060705
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