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.

The role of ERK1/2 signaling pathway in coronary microembolization-induced rat myocardial inflammation and injury

Objectives In this work,we explore the effect of atorvastatin on myocardial apoptosis and caspase-8 acti- vation after coronary microembolization(CME) in rats. Methods Fifty rats were randomly divided into five groups; the coronary microembolization(CME) group,the sham-operated (sham) control group,the gastric lavage control group, the atorvastatin lavage group,and the caspasse-8 inhibitor (N-acetyl-Ile-Glu-Thr-Asp-CHO,abbreviated as CHO) group,with 10 rats for each group.A microembolization ball was injected through the left ventricle for constructing the CME model.Animals in the sham control group were given an injection of physiological saline instead of the microembolization ball.Seven days before the operation,the atorvastatin group underwent gastric lavage with 20 mg/kg of atorvastatin once a day.Gastric lavage control animals underwent gastric lavage with an equivalent dose of physiological saline instead of the atorvastatin.Animals in the CHO group were given an intraperitoneal injection of 10 mg/kg of CHO 30 min before the operation.Six hours after the operation,cardiac ultrasonic detection was conducted on each group to measure the cardiac function indexes.TUNEL(Terminal-deoxynucleoitidyl transferase mediated dUTP nick end labeling) assays were used to measure myocardial apoptosis,and western blots were used to quantify the expression levels of activated caspase-3 and -8.Results(1) The echocardiographic parameters showed that,compared to the sham control animals,the left ventricular ejection fraction(LVEF) of the CME group was significantly decreased(P【0.05).In addition, cardiac sonography revealed a decrease in the left ventricular shortening fraction(FS) and cardiac output(CO), but an increase in the left ventricular end-diastolic dimension (LVEDd).Compared to the CME group,the atorvastatin and CHO groups exhibited significantly improved cardiac function (P【0.05).(2) When compared with the sham control,the myocardical apoptotic rate of the CME group,as well as the levels of activated caspase-3 and-8,increased significantly (P【0.05).The myocardial apoptotic rate,as well as the levels of activated caspase-3 and caspase-8 in the atorvastatin and CHO groups,decreased significandy(P【0.05) in comparison to the CME group.Conclusions The atorvastatin pretreatment clearly suppressed post-CME myocardial apoptosis and improved cardiac function.The most likely mechanism for these effects is the blockade of the myocardial death receptor -mediated apoptosis pathway.

Effect of Danhong Injection(丹红注射液)on Improving Coronary Microcirculation Injury after Percutaneous Coronary Intervention

Objective:To explore the effectiveness of Danhong Injection(丹红注射液)on improving microcirculatory injury after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:A randomized controlled trial was conducted and 90 patients were enrolled.A random sequence was generated using statistical analysis software.Patients with microcirculatory injuries after PCI were randomly divided into 3 groups for treatment(30 subjects in each group):Danhong Injection group:after PCI,Danghong Injections were given with intravenous administration with 40 mL twice a day for a week;statins intensive group:after PCI,atorvastatin calcium tablets were given oral medication with 80 mg once,and then atorvastatin 40 mg daily for 1 week;the control group:after PCI,atorvastatin calcium tablets were given oral medication with 10–20 mg daily for 1 week.The index of microcirculation resistance(IMR)was used to assess microcirculatory injury during PCI.The IMR of the target vessel was reexamined after 1 week of drug treatment.Results:After one week's drug treatment,IMR was significantly decreased in both statins intensive group and Danhong Injection group compared with the control group(P<0.01),but no difference was found between statins intensive group and Danhong injection group(14.03±2.54 vs.16.03±5.72 U,P=0.080).Conclusions:The efficacy of Danhong Injection is non-inferior to statin.Early use of Danhong Injection after PCI can effectively improve coronary microcirculation injury after PCI.

Effects of Qishen Yiqi Dripping Pills(芪参益气滴丸) in Reducing Myocardial Injury and Preserving Microvascular Function in Patients Undergoing Elective Percutaneous Coronary Intervention:A Pilot Randomized Study

Objectives：To evaluate the effect of treatment with Qishen Yiqi Dripping Pills（芪参益气滴丸,QSYQ） on myocardial injury and myocardial microvascular function in patients undergoing elective percutaneous coronary intervention（PCI）.Methods：Eighty patients undergoing elective PCI were randomly assigned to QSYQ and control groups.The QSYQ group received QSYQ at a dosage of 0.5 g 3 times daily（3–7 days before PCI and then daily for 1 month） and regular medication,which comprised of aspirin,clopidogrel,statin,β-blocker,and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the absence of contradiction.The control group received only the regular medication.The index of microcirculatory resistance（IMR） was measured at maximal hyperemia after PCI.The fractional flow reserve was measured before and after the procedure.Troponin Ⅰ levels were obtained at baseline and 20–24 h after the procedure.Results：Pre-PCI troponin Ⅰ levels between the two groups were similar（0.028±0.05 vs.0.022±0.04 ng/m L,P=0.55）.However,postPCI troponin Ⅰ levels in the QSYQ group were significantly lower than that in the control group（0.11±0.02 vs.0.16±0.09 ng/m L,P〈0.01）.IMR values were significantly lower in the QSYQ group as compared to the control group（16.5±6.1 vs.31.2±16.0,P〈0.01）.Multivariate analysis identified QSYQ treatment as the only independent protective factor against IMR 〉32（odds ratio=0.29,95% confidence interval：0.11–0.74,P=0.01）.Conclusion：The present study demonstrated the benefit of QSYQ in reducing myocardial injury and preserving microvascular function during elective PCI.