The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting

Medalion, Benjamin; Cohen, Hilit; Assali, Abid; Assa, Hana Vaknin; Farkash, Ariel; Snir, Eitan; Sharoni, Erez; Biderman, Philip; Milo, Gai; Battler, Alexander; Kornowski, Ran; Porat, Eyal E.

doi:10.1016/j.jtcvs.2009.08.042

Cited by 84 publications

(61 citation statements)

References 21 publications

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“…235 Most studies evaluating the benefits of CABG in patients with ventricular arrhythmias have examined survivors of out-of-hospital cardiac arrest as well as patients with inducible ventricular tachycardia or fibrillation during electrophysiological study. [272][273][274] In general, CABG has been more effective in reducing the occurrence of ventricular fibrillation than of ventricular tachycardia, because the mechanism of the latter is usually reentry with scarred endocardium rather than ischemia. Observational studies have demonstrated a favorable prognosis of subjects undergoing CABG for ischemic ventricular tachycardia/fibrillation.…”

Section: Emergencymentioning

confidence: 99%

“…248 In survivors of cardiac arrest who have severe but operable CAD, CABG can suppress the appearance of arrhythmias, reduce subsequent episodes of cardiac arrest, and result in a good long-term outcome. [271][272][273] It is particularly effective when an ischemic cause of the arrhythmia can be documented (for instance, when it occurs with exercise). 275 Still, because CABG may not alleviate all the factors that predispose to ventricular arrhythmias, concomitant insertion of an implantable cardioverter-defibrillator is often warranted.…”

Section: Emergencymentioning

confidence: 99%

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2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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Section: Emergencymentioning

confidence: 99%

Section: Emergencymentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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“…It has been shown that cardiac surgery within 24 h of angiography is not safe. In the case of large contrast dose administration it is better to postpone surgery for five days [151,152] . Sufficient hydration is protective not only in patients at risk of contrast-induced nephropathy [153] , but also in patients with underlying renal insufficiency [154] .…”

Section: Preventive Measuresmentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

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“…Acute renal replacement will be required for 3% 5 to 15% 6 of CI-AKI patients. Hospitalized patients complicated by CI-AKI, compared to patients with similar premorbid characteristics, experience longer hospital stays [6][7][8] ; and suffer significantly higher in-hospital [9][10][11] and long-term 12 mortality rates. Those patients who survive CI-AKI are then predisposed to continued loss of kidney function.…”

mentioning

confidence: 99%

Does the Current Definition of Contrast‐induced Acute Kidney Injury Reflect a True Clinical Entity?

Sinert

Brandler

Subramanian

et al. 2012

Academic Emergency Medicine

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Objectives: Contrast-induced acute kidney injury (CI-AKI) is defined as either a 25% increase in or an absolute elevation in serum creatinine (SCr) of 0.5 mg/dL, 48 to 72 hours after parenteral contrast exposure. The objective of this study was to compare the incidence and complications of AKI between patients exposed and those unexposed to intravenous (IV) contrast.Methods: This was a retrospective cohort study using the electronic medical record of adult patients (>18 years) with and without contrast-enhanced abdominal or chest computed tomography (CT) between May 2008 and April 2009. Inclusion criteria were emergency department (ED) patients with normal renal function who received either a contrast-enhanced abdominal or a contrast-enhanced chest CT, compared to those unexposed to IV contrast, with a repeat SCr within 48 to 72 hours. Exclusion criteria were contrast exposure within 7 days before the index visit. CI-AKI in the contrast-exposed group and AKI in the contrast-unexposed group were defined by the same changes in SCr 48 to 72 hours after contrast or ED admission. Data were described by proportions or medians with 95% confidence intervals (CIs) or interquartile ranges (IQR; 25% to 75%). Group comparisons were by Mann-Whitney U or Fisher's exact test (a = 0.05, two tails).Results: The contrast-exposed (n = 773) and contrast-unexposed (n = 2,956) patients were evenly matched for initial demographic, renal, and metabolic parameters. The incidence of CI-AKI/AKI was significantly higher for the patients unexposed versus exposed to contrast (8.96% vs. 5.69%, p = 0.003). There was no significant difference in mortality rates between contrast-exposed and unexposed patients (9.09% vs. 6.79%, p = 0.533). Conclusions:The definition of CI-AKI for ED patients with normal renal function may not represent a true clinical entity and the definition warrants revision.

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The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting

Abstract: Whenever possible, coronary bypass grafting should be delayed for at least 5 days in patients who received a high contrast dose, especially if they also have preoperative reduced renal function.

Cited by 84 publications

References 21 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Does the Current Definition of Contrast‐induced Acute Kidney Injury Reflect a True Clinical Entity?

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