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PowerPoint Slides for: Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study
<p><b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, <i>p</i> < 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, <i>p</i> < 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, <i>p</i>
< 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. <b><i>Conclusions:</i></b> 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.</p