Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Outcomes of Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention in Patients Aged 18-45 Years with Diabetes Mellitus

Background：Debate on treatment for young patients with coronary artery disease still exists.This study aimed to investigate the intermediate-and long-term outcomes between coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） in patients aged 18-45 years with diabetes mellitus （DM）.Methods：Between January 2006 and March 2016,a total of 2018 DM patients aged 18-45 years including 517 cases of CABG and 1501 cases of PCI were enrolled in the study.Using propensity score matching （PSM）,406 patients were matched from each group.The intermediate-and long-term data were collected.The primary end point of this study was long-term death.The secondary end points included long-term major adverse cardiovascular and cerebrovascular events （MACCEs）,stroke,angina,myocardial infarction （MI）,and repeat revascularization.Results：Before PSM,the in-hospital mortality was 1.2% in the CABG group and 0.1% in the PCI group,with statistically significant difference （P 〈 0.0001）.The 10-year follow-up outcomes including long-term survival rate and freedom from MACCEs were better in the CABG group than those in the PCI group （97.3% vs.94.5%,P =0.0072;93.2% vs.86.3%,P 〈 0.0001）,but CABG group was associated with lower freedom from stoke compared to PCI group （94.2% vs.97.5%,P =0.0059）.After propensity score-matched analysis,these findings at 10-year follow-up were also confirmed.Freedom from MACCEs was higher in CABG group compared to PCI group,but no significant difference was observed （93.1% vs.89.2%,P =0.0720）.The freedom from recurrent MI was significantly higher in CABG patients compared with PCI patients （95.6% vs.92.5%,P =0.0260）.Furthermore,CABG was associated with a higher rate of long-term survival rate than PCI （97.5% vs.94.6%,P =0.0403）.There was no significant difference in the freedom from stroke between CABG and PCI groups （95.3% vs.97.3%,P =0.9385）.The hospital cost was greater for CABG （13,936 ± 4480 US dollars vs.10,926 ± 7376 US dollars,P 〈 0.0001）.Conclusions：In DM patients aged 18-45 years,the cumulative survival rate,and freedom from MI and repeat revascularization for CABG were superior to those of PCI.However,a better trend to avoid stroke was observed with PCI.