Acute Kidney Injury After CABG Versus PCI: An Observational Study Using 2 Cohorts

Study Questions:

What is the risk of acute kidney injury (AKI) after multivessel coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI) as an initial revascularization strategy?


This was a retrospective analysis of patients undergoing first documented coronary revascularization using two complementary cohorts: 1) Kaiser Permanente Northern California (KPNC), a diverse, integrated health care delivery system; and 2) Medicare beneficiaries, a large, nationally representative, older cohort. The investigators defined AKI in the KPNC cohort by an increase in serum creatinine of ≥0.3 mg/dl or ≥150% above baseline, and in the Medicare cohort by discharge diagnosis codes and use of dialysis.


The incidence of AKI was 20.4% in the KPNC cohort and 6.2% in the Medicare cohort. The incidence of AKI requiring dialysis was <1%. CABG was associated with a 2- to 3-fold significantly higher adjusted risk of developing AKI compared with PCI in both cohorts.


The authors concluded that AKI is common after multivessel coronary revascularization, and more likely after CABG than after PCI.


This study reports that AKI during the index hospitalization was common after either type of coronary revascularization, and CABG was associated with a significant 1.5- to 3-fold higher odds of AKI compared with PCI, even after accounting for differences in baseline characteristics and treatments between groups. These findings emphasize the need to include the risk for AKI when considering revascularization strategies for multivessel coronary disease, and to continue to work to decrease the high incidence of AKI after coronary revascularization overall.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Renal Dialysis, Acute Kidney Injury, Coronary Disease, Creatinine, Medicare, Coronary Artery Bypass, Angioplasty, Balloon, Coronary

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