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J Thorac Cardiovasc Surg 2009;138:971-976
© 2009 The American Association for Thoracic Surgery

Perioperative Management

Preoperative renal function as a predictor of survival after coronary artery bypass grafting: Comparison with a matched general population

Albert H.M. van Straten, MDa, Mohamed A. Soliman Hamad, MDa,*, André A.J. van Zundert, MD, PhD, FRCAb, Elisabeth J. Martens, PhDc, Jacques P.A.M. Schönberger, MD, PhDa, Andre M. de Wolf, MDd

a Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
b Department of Anesthesiology, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands, and University Hospital Ghent, Ghent, Belgium
c Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands, and Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands
d Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill

Received for publication December 24, 2008; revisions received March 24, 2009; accepted for publication May 20, 2009.

* Address for reprints: Mohamed A. Soliman Hamad, MD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, The Netherlands. (Email: aasmsn{at}cze.nl).

Objective: Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization. We studied how renal function affects long-term survival of patients after coronary artery bypass grafting.

Methods: Early and late mortality were determined retrospectively among consecutive patients having isolated coronary bypass at a single Dutch institution between January 1998 and December 2007. Patients were stratified into 4 groups according to preoperative renal function. Expected survival was gauged using a general Dutch population group that was obtained from the database of the Dutch Central Bureau for Statistics; for each of our renal function groups, a general population group was assembled by matching for age, gender, and year of operation.

Results: After excluding 122 patients lost to follow-up, 10,626 patients were studied; in 10,359, preoperative creatinine clearance could be calculated. Multivariate logistic regression and Cox regression analysis identified renal dysfunction as a predictor for early and late mortality. When long-term survival of patient groups was compared with expected survival, only patients with a creatinine clearance less than 30 mL · min–1 showed a worse outcome. Patients with a creatinine clearance between 60 and 90 mL · min–1 had a long-term survival exceeding the expected survival.

Conclusions: Severity of renal dysfunction was related to poor survival. When compared with expected survival, however, patients having coronary bypass had a worse outcome only when severe preoperative renal dysfunction was present.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CBS = Central Bureau for Statistics; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; CrCl = creatinine clearance; ECC = extracorporeal circulation; EF = ejection fraction; PVD = peripheral vascular disease






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