title: Acute kidney injury after CABG versus PCI: an observational study using 2 cohorts.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a known complication after coronary revascularization, but few studies have directly compared the incidence of AKI after coronary artery bypass surgery (CABG) or after percutaneous coronary intervention (PCI) in similar patients.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether multivessel CABG compared with PCI as an initial revascularization strategy is associated with a higher risk for AKI.
  
  
  METHODS
  A retrospective analysis of patients undergoing first documented coronary revascularization was conducted using 2 complementary cohorts: 1) Kaiser Permanente Northern California, a diverse, integrated health care delivery system; and 2) Medicare beneficiaries, a large, nationally representative older cohort. AKI was defined in the Kaiser Permanente Northern California cohort by an increase in serum creatinine of ≥0.3 mg/dl or ≥150% above baseline and in the Medicare cohort by discharge diagnosis codes and the use of dialysis.
  
  
  RESULTS
  The incidence of AKI was 20.4% in the Kaiser Permanente Northern California cohort and 6.2% in the Medicare cohort. The incidence of AKI requiring dialysis was <1%. CABG was associated with a 2- to 3-fold significantly higher adjusted odds for developing AKI compared with PCI in both cohorts.
  
  
  CONCLUSIONS
  AKI is common after multivessel coronary revascularization and is more likely after CABG than after PCI. The risk for AKI should be considered when choosing a coronary revascularization strategy, and ways to prevent AKI after coronary revascularization are needed.
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Tara I
authors.initials: TI
authors.lastname: Chang
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Leong
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.affiliation: Stanford University School of Medicine, Stanford, California; Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.affiliation: Stanford University School of Medicine, Stanford, California; Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology, Biostatistics, and Medicine, University of California-San Francisco, San Francisco, California. Electronic address: alan.s.go@kp.org.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis
keywords: acute kidney injury; coronary revascularization; renal