title: Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery.
abstract: BACKGROUND
  Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of preoperative (mild) renal dysfunction as a long-term predictor of clinical outcome after coronary bypass surgery.
  
  
  METHODS
  In 358 patients who underwent isolated saphenous vein aorta-coronary artery bypass grafting, estimated glomerular filtration rates were calculated with the Cockroft-Gault equation (GFRc). Patients were categorized into 2 groups (group 1, GFRc >71.1 mL x min (-1) x 1.73 m (-2) ; group 2, GFRc <71.1 mL x min (-1) x 1.73 m (-2) ). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic value of GFRc.
  
  
  RESULTS
  During a median follow-up of 18.2 years, 233 patients (65.1%) died. Patients who died had lower GFRc and were older. Multivariate analysis demonstrated that total mortality in patients with lower GFRc was significantly increased (lower GFRc group vs normal GFRc group: hazard ratio, 1.44; P = .019). Lower GFRc was also an independent predictor of cardiac mortality (hazard ratio, 1.51; P = .032). No significant differences were observed between groups in the occurrence of myocardial infarction and the need for reintervention.
  
  
  CONCLUSIONS
  Our study demonstrates that after long-term follow-up, preoperative mild renal dysfunction is an independent predictor of long-term (cardiac) mortality in patients who undergo coronary artery bypass grafting.
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands. r.wal@antonius.net <r.wal@antonius.net>
authors.forename: Ruud M A
authors.initials: RM
authors.lastname: van de Wal
authors.forename: Ben L
authors.initials: BL
authors.lastname: van Brussel
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Tom D J
authors.initials: TD
authors.lastname: Smilde
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Henry A
authors.initials: HA
authors.lastname: van Swieten
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
authors.forename: Dirk Jan
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: H W Thijs
authors.initials: HW
authors.lastname: Plokker
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D051437:Renal Insufficiency / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D012086:Reoperation; D012720:Severity of Illness Index; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome