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Kidney Week

Abstract: TH-PO028

Temporal Trends in the Inpatient Mortality of Patients with AKI After Coronary Revascularization in a Nationwide Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Bhandary, Siddartha, Providence Hospital, Washington, District of Columbia, United States
  • Ahn, Jaeil, Georgetown University, Washington, District of Columbia, United States
  • Shen, Wen, Georgetown 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 studies have shown that both CABG and PCI were associated with increasing temporal trends in AKI incidence over the years; and in-hospital mortality after CABG was more than 40% higher than that of PCI. In this study, we compared the temporal trends of total in-hospital mortality, and in-hospital mortality associated with AKI after CABG vs PCI.

Methods

We generated a propensity-matched cohort of 274,464 hospitalizations that had first time CABG or PCI for multi-vessel coronary disease in 2004 to 2012 from the National Inpatient Sample. Patients received concomitant valvular repair or both CABG and PCI on same admission, history of organ transplant, CKD stage V or ESRD on dialysis were excluded. Both groups were propensity score matched. The odds ratios were estimated by the random intercept logistic regression model.

Results

The temporal trends of in-hospital mortality in CABG-AKI group had been decreasing from 16.52 % in 2004 to 6.51% in 2012 whereas in the PCI- AKI group, the in-hospital mortality has been stable, 14.17% in 2004 to 13.11% in 2012. Compared to PCI-AKI group, the likelihood of in-hospital death for CABG- AKI group in 2004 was 20 % higher (OR 1.20, 95% CI 0.89-1.61, P=0.35). But after 2004, the odds reversed. . From 2005 to 2012, the odds of in-hospital death in the patients with post-CABG AKI became 23%-54% lower than the PCI-AKI group (OR 0.77, 95% CI 0.60-0.99, P=0.05; OR 0.46, 95%CI 0.36-0.59, P<0.0001). Interestingly, when we compared the overall in-hospital mortality between both groups irrespective of the kidney function, CABG was associated with higher in-hospital mortality from 2004-2010 than PCI group with down-trending ORs. In 2011 and 2012, PCI was associated with higher in-hospital mortality.

Conclusion

CABG patients with post procedural AKI have shown a decreasing temporal trends in in-hospital mortality over the years whereas the in-hospital mortality remains high in the PCI patients with AKI.