title: Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study.
abstract: BACKGROUND
  Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent.
  
  
  METHODS
  We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups.
  
  
  RESULTS
  The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges.
  
  
  CONCLUSIONS
  Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.
authors.affiliation: Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Shen
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Aguilar
authors.forename: Alex R
authors.initials: AR
authors.lastname: Montero
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Fernandez
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Wilcox
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lipkowitz
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D058017:Vascular Grafting