title: Acute kidney injury after coronary artery bypass grafting and long-term risk of myocardial infarction and death.
abstract: BACKGROUND
  Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with early mortality. Its impact on the risk of myocardial infarction (MI) over time and long-term mortality has not been well described.
  
  
  METHODS
  We performed a nationwide population-based cohort study in 27,929 patients who underwent a first isolated CABG between 2000 and 2008 in Sweden. Acute kidney injury was divided into three categories based on the absolute increase in postoperative serum creatinine (sCr) concentration compared with the preoperative baseline: stage 1, sCr increase of 0.3 to 0.5mg/dL; stage 2, sCr increase of >0.5 to 1.0mg/dL and stage 3, sCr increase of ≥ 1.0mg/dL.
  
  
  RESULTS
  The overall incidence of postoperative AKI was 13%, 6.3% met the criterion for stage 1, 4.3% for stage 2 and 2.3% for stage 3. During a mean follow-up of 5.0 years, there were 2119 (7.6%) MIs and 4679 (17%) deaths. Multivariable adjusted hazard ratios with 95% confidence intervals for MI were 1.35 (1.15 to 1.57), 1.80 (1.53 to 2.13) and 1.63 (1.29 to 2.07), in AKI stages 1, 2 and 3, respectively. The corresponding hazard ratios for all-cause mortality were 1.30 (1.17 to 1.44), 1.65 (1.48 to 1.83) and 2.68 (2.37 to 3.03), respectively.
  
  
  CONCLUSIONS
  Our results show that AKI after CABG is associated with an increased long-term risk of MI and death.
authors: Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: Linda.ryden@karolinska.se.
authors: Linda
authors: L
authors: Rydén
authors: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors: Staffan
authors: S
authors: Ahnve
authors: Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors: Max
authors: M
authors: Bell
authors: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; AstraZeneca R&D, Mölndal, Sweden.
authors: Niklas
authors: N
authors: Hammar
authors: Department Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors: Torbjörn
authors: T
authors: Ivert
authors: Department Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors: Ulrik
authors: U
authors: Sartipy
authors: Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital, Sweden.
authors: Martin J
authors: MJ
authors: Holzmann
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Coronary artery bypass grafting; Myocardial infarction; Prognosis