European Heart Journal Advance Access originally published online on February 15, 2007
European Heart Journal 2007 28(7):865-871; doi:10.1093/eurheartj/ehl508
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Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting
1 Department of Emergency Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
2 Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
3 Epidemiology, AstraZeneca Research and Development, Mölndal, Sweden
4 Department of Preventive Medicine at Stockholm Centre of Public Health, Karolinska Institute, Stockholm, Sweden
5 Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
6 Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
Received 1 October 2006; revised 10 December 2006; accepted 12 January 2007; online publish-ahead-of-print 15 February 2007.
* Corresponding author. Tel: +46 8 51770000; fax: +46 8 51770990 E-mail address: martin.holzmann{at}karolinska.se
See page 782 for the editorial comment on this article (doi:10.1093/eurheartj/ehm014)
Aims: To evaluate the impact of renal insufficiency (RI) on long-term mortality and incident myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG).
Methods and results: All patients (n = 6575) without dialysis-dependent RI undergoing a first isolated CABG during 1980–1995 at the Karolinska hospital who survived 30 days post-operatively were included. Estimated glomerular filtration rate (eGFR) was related to the incidence of MI and all-cause mortality within 5 years. There were 628 deaths and 496 incident MIs during follow-up. After multivariable adjustment, patients with mild (eGFR 60–90 mL/min), moderate (eGFR 30–60 mL/min), and severe (eGFR <30 mL/min) RI had an increased mortality within 5 years post-CABG; hazard ratio (HR) 1.2 [95% confidence interval (CI) 1.0–1.6], HR 1.8 (95% CI 1.3–2.4), and HR 5.2 (95% CI 3.1–8.6), respectively, compared with patients with normal renal function (eGFR >90 mL/min). In patients with moderate and severe RI, there was an increased incidence of MI; HR 1.5 (95% CI 1.1–2.1) and HR 3.5 (95% CI 1.8–6.8), respectively. There were no gender differences.
Conclusion: Already mild RI predicts late all-cause mortality after coronary artery bypass grafting (CABG), and moderate and severe RI is associated with an increased long-term incidence of MI post-CABG.
Key Words: Renal insufficiency • Coronary artery bypass • Mortality • Myocardial infarction
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