title: The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive.
  
  
  METHODS
  A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis.
  
  
  RESULTS
  Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on >1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014).
  
  
  CONCLUSIONS
  Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.
authors.affiliation: Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. Electronic address: giovannimariscalco@yahoo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Cottini
authors.affiliation: Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dominici
authors.affiliation: Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: Department of Heart and Vessels, Vascular Surgery Unit, Varese University Hospital, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.affiliation: Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borsani
authors.affiliation: Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Vito Domenico
authors.initials: VD
authors.lastname: Bruno
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Corazzari
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gherli
authors.affiliation: Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute kidney injury; CPB; Cardiac catheterization; Cardiac surgery; Cardiopulmonary bypass