HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rajendra H. Mehta Eric D. Peterson Michael J. Mack Nicholas T. Kouchoukos T. Bruce Ferguson, Jr. John H. Alexander Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mehta, R. H. Search for Related Content PubMed Articles by Mehta, R. H. Related Collections Coronary disease

J Thorac Cardiovasc Surg 2008;136:1149-1155
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Influence of preoperative renal dysfunction on one-year bypass graft patency and two-year outcomes in patients undergoing coronary artery bypass surgery

^a Duke Clinical Research Institute and Duke University Medical Center, Durham, NC
^b Beth Israel Deaconess Medical Center, Boston, Mass
^c Medical City Hospital, Dallas, Tex
^d Missouri Baptist Medical Center, St Louis, Mo
^e East Carolina University, Greenville, NC

Received for publication August 21, 2007; revisions received December 12, 2007; accepted for publication February 19, 2008.

^_* Address for reprints: Rajendra H. Mehta, MD, MS, Box 17969, Duke Clinical Research Institute, Durham, NC 27715. (Email: mehta007{at}dcri.duke.edu).

Objective: Limited information exists on the impact of preoperative renal dysfunction on internal thoracic artery and saphenous vein graft failure and 2-year clinical outcomes in patients undergoing coronary artery bypass surgery.

Methods: We studied the impact of preoperative renal dysfunction (creatinine clearance < 60 mL/min) on 1-year internal thoracic artery and saphenous vein graft failure (defined as 75% angiographic stenosis) and 2-year clinical events (death; death or myocardial infarction; and death, myocardial infarction, or revascularization) in 3014 patients undergoing coronary artery bypass surgery enrolled in the Project of Ex-vivo Vein Graft Engineering via Transfection-IV study.

Results: Of 2973 patients (98.6%) with preoperative measurement of renal function, 440 (14.8%) had renal dysfunction. Most baseline comorbidities were higher in these patients. Two-year clinical events were higher in patients with preoperative renal dysfunction (adjusted death, myocardial infarction, or revascularization, hazard ratio 1.21, 95% confidence interval 0.97–1.50; adjusted death or myocardial infarction, hazard ratio 1.35, 95% confidence interval 1.05–1.74; adjusted death, hazard ratio 1.47, 95% confidence interval 0.98–2.21). However, saphenous vein graft (odds ratio 1.02, 95% confidence interval 0.79–1.33) and internal thoracic artery (odds ratio 0.76, 95% confidence interval 0.40–1.44) failure were similar in the 2 groups.

Conclusion: Although the risk of adverse clinical events is higher in patients with preoperative renal dysfunction, that of internal thoracic artery and saphenous vein graft failure is not. This suggests that factors other than graft failure account for the worse clinical outcomes in this high-risk cohort. Further studies are needed to identify other mechanisms of these worse outcomes so that appropriate measures can be developed to improve long-term outcomes in patients with renal dysfunction undergoing coronary artery bypass surgery.