Acute Kidney Injury in Patients Undergoing Cardiac Surgery and Coronary Angiography on the Same Day

BACKGROUND: Contrast media used for coronary angiography may result in a contrast-induced nephropathy. Acute kidney injury (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. However, data from the existing literature are conflicting. The aim of this study is to investigate the risk of AKI in patients undergoing angiography and cardiac surgery on the same day, and to assess the efficacy of a policy limiting this practice.

METHODS: A total of 4,440 consecutive patients receiving coronary angiography and cardiac surgery at our institution were retrospectively analyzed. The AKI was defined as stage 1 or stage 2-3 according to the existing classification. 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.

RESULTS: Surgery on the day of angiography was an independent risk factor for AKI stage 2-3 (odds ratio 1.58, 95% confidence interval 1.04 to 2.40). An institutional policy limiting the practice of surgery on the same day of angiography (years 2009 to 2012) resulted in a significant (p = 0.001) 30% decrease of AKI stage 1 and 42% decrease of any AKI with respect to patients operated in the years 2003 to 2008.

CONCLUSIONS: Acute kidney injury after cardiac surgery is a multifactorial event; surgery on the same day of angiography significantly increases the risk of AKI, and limiting this practice results in a containment of the postoperative AKI incidence.