Concurrent Angiography and Cardiac Surgery Promote Kidney Injury

A new study confirms that performing heart surgery on the same day as angiography is a risk factor for acute kidney injury (AKI).

Researchers at the Policlinico San Donato (Milan, Italy) reviewed and retrospectively analyzed a total of 4,440 consecutive patients receiving coronary angiography and cardiac surgery. Predictive models for AKI stage 1, stage 2-3, and any AKI were built, including various risk factors and the occurrence of surgery on the same day of angiography; AKI was defined as stage 1 or stage 2-3 according to existing classification. The aim of the study was to investigate the risk of AKI in these patients and to assess the efficacy of a policy implemented at the hospital to limit same day procedures.

The results showed that surgery on the day of angiography was an independent risk factor for AKI stage 2-3, with an odds ratio of 1.58. An institutional policy limiting the practice of surgery on the same day of angiography—as practiced between 2009 and 2012—resulted in a significant 30% decrease of AKI stage 1, and a 42% decrease of any AKI, when compared to patients operated on in the years 2003 to 2008. The study was published in the February 2013 issue of the Annals of Thoracic Surgery.

“Both cardiac surgery and the use of contrast media are risk factors for AKI. It appears that the combination of these factors on the same day significantly increases the risk,” said lead author Marco Ranucci, MD. “We recommend that angiography on the same day as surgery should be avoided or at least limited to low-risk cases. In patients at high risk for AKI, such as elderly patients or patients with preexisting renal dysfunction, surgery should be planned at least 24 hours after angiography.”

AKI is a common complication of cardiac surgery. It has been hypothesized that cardiac surgery in close succession to coronary angiography may increase the risk of postoperative AKI due to the use of contrast media, leading to induced nephropathy.

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