Impact of urgent coronary artery bypass grafting on acute kidney injury A matched cohort study

Objectives There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after U-CABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation. Results U-CABG patients showed a higher incidence of AKI (49.8% vs. E-CABG: 39.7%; p = 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U-CABG patients (12.6%) compared to E-CABG patients (2.3%; p < 0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2 + 3) and mortality (stage 1: OR 2.409, 95% CI 1.017-5.706; p = 0.046 vs. stage 2 + 3: OR 5.577; 95% CI 2.033-15.3; p = 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. Conclusions U-CABG is a risk factor for postoperative AKI and even mild AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.

Automated summary

Urgent coronary artery bypass graft (U-CABG) surgery is associated with a higher incidence of postoperative acute kidney injury (AKI) and mortality compared to elective CABG. Higher AKI stages (2 + 3) are strongly correlated with mortality, and preoperative renal impairment, peripheral vascular disease, and transfusion of more than two red blood cell concentrates are predictors of postoperative AKI.