Abstract: SA-PO002

Temporal Trends in the Incidence of AKI after Coronary Revascularization in a Nationwide Study

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Shen, Wen, Georgetown University Hospital, DC, Washington, United States
  • Bhandary, Siddartha, Providence Hospital, Derwood, Maryland, United States
  • Ahn, Jaeil, Georgeotown University, Washington, District of Columbia, United States
Background

The major modalities of coronary revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) both carry high risk of acute kidney injury (AKI). Our previous study has shown that CABG was associated with higher incidence of post-procedural AKI compared with PCI. Since the temporal trends of AKI incidence in the general population have been changing, it is important to study the temporal changes of AKI incidence in CABG and PCI which could help us better understand the risk profile migration over the years in the coronary revascularization modalities.

Methods

We generated a propensity-matched cohort of 274,464 hospitalizations that had first time CABG or PCI for multivessel coronary disease in 2004 to 2012 from the National Inpatient Sample. Patients received concomitant valvular repair or both CABG and PCI on the same admission, history of organ transplant, CKD stage V or ESRD on dialysis were excluded. Both groups were propensity score matched for age, gender, race, payer, prior MI, unstable angina, heart failure, CVA, peripheral arterial disease, valvular disease, atrial flutter or fibrillation, CKD, diabetes, HTN, dyslipidemia, smoking, cirrhosis, COPD, systemic cancer, obesity, and anemia. The odds ratios were estimated by the random intercept logistic regression model.

Results

The temporal trends of AKI incidence in both CABG and PCI groups had been increasing over the years from 5.9% in 2004 up to 14.2% in 2012 for CABG, 2.7% in 2004 up to 8.8% in 2012 for PCI. Compared with PCI, CABG was associated with higher incidence of post-procedural AKI in each individual year from 2004 to 2012 (Time effect: OR 1.138, 95% CI: 1.113-1.164, P <0.01). Interestingly, although CABG had higher likelihood to develop AKI throughout the study period than PCI, the odds had been decreasing gradually (OR 3.29, 95% CI 3.08-3.54, P<0.01 in 2006; OR 1.73, 95% CI 1.58-1.88, P<0.01 in 2012).

Conclusion

Both CABG and PCI were associated with increasing temporal trends in AKI incidence over the years. Although CABG was associated with higher likelihood of developing post-procedural AKI in each individual year compared to PCI, the odds had been decreasing yearly.

Funding

  • Clinical Revenue Support