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Coronary computed tomography angiography before on-pump cardiac surgery does not reduce the risk of postoperative acute kidney injury compared to coronary angiography

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Abstract

Objectives

Cardiac surgery and contrast media are both related to acute kidney injury. We investigated whether undergoing coronary computed tomography angiography, which uses less contrast medium, before on-pump cardiac surgery could reduce the risk of postoperative acute kidney injury compared to coronary angiography.

Methods

In this retrospective study, 745 and 171 patients underwent coronary angiography and coronary computed tomography angiography, respectively, within 30 days before on-pump cardiac surgery. Postoperative acute kidney injury was defined according to Kidney Disease Improving Global Outcomes Definition and Staging criteria.

Results

Age, hypertension, cardiopulmonary bypass time, and performing cardiac surgery within 24 h of preoperative angiography (odds ratio: 1.507, 95% confidence interval: 1.111‒2.045, P = 0.008) independently predicted postoperative acute kidney injury on multivariable analysis. After propensity score matching, the acute kidney injury incidence in coronary angiography and computed tomography angiography groups was 43% and 46%, respectively (P = 0.65), and the groups had similar intensive care unit stay (2 days vs. 2 days, P = 0.209), postoperative hospital stay (11 days vs. 12 days, P = 0.084), postoperative continuous renal replacement therapy use (0.6% vs 1.9%, P = 0.314), and in-hospital mortality (0 vs. 1.3%, P = 0.156). In-hospital outcomes were similar among patients who underwent preoperative coronary angiography or computed tomography angiography within 24 h before cardiac surgery.

Conclusion

Although coronary computed tomography angiography uses less contrast medium, it does not reduce the risk of postoperative acute kidney injury or improve in-hospital outcomes compared to coronary angiography.

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Funding

This study was supported by grants from National Natural Science Foundation of China (No. 81800581), Natural Science Basic Research Program of Shaanxi (No. 2019JQ-952) and Fundamental Research Funds for the Central Universities (No. xjj2018276).

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061, Shaanxi, China

    Yang Yan, Yongxin Li, Jing Li, Yongjian Zhang, Fengfeng Liu & Xinglong Zheng

  2. Department of Blood Purification, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Wenyan Liu

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  1. Yang Yan
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Correspondence to Xinglong Zheng.

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Yan, Y., Li, Y., Liu, W. et al. Coronary computed tomography angiography before on-pump cardiac surgery does not reduce the risk of postoperative acute kidney injury compared to coronary angiography. Gen Thorac Cardiovasc Surg 69, 1445–1452 (2021). https://doi.org/10.1007/s11748-021-01602-8

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  • DOI: https://doi.org/10.1007/s11748-021-01602-8

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