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Original Articles: Adult Cardiac

Impact of Renal Dysfunction on Long-Term Survival After Isolated Coronary Artery Bypass Surgery

^a Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
^b Division of Biometrices National Center for Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Accepted for publication January 27, 2009.

^_* Address correspondence to Dr Hu, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Science, 167A Beilishi Rd, Xi Chen District, Beijing, 100037, Peoples Republic of China (Email: shengshouhu{at}yahoo.com).

Background: Preoperative renal dysfunction has been an important predictor for adverse cardiovascular events after coronary artery bypass grafting (CABG). In the past, serum creatinine was widely used to assess renal function. Until recently, estimated glomerular filtration rate (eGFR) was recommended in evaluating renal function. The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) equation are two widely used formulas in clinical practice. Which method best predicts long-term outcome after CABG is still unknown. This study compared the predictive effectiveness of the Cockcroft-Gault formula, the MDRD equation, and serum creatinine level for in-hospital and long-term mortality.

Methods: We retrospectively reviewed data collected from 5559 patients who underwent isolated CABG at Fuwai Hospital from January 1999 to December 2005. The main outcomes were in-hospital and long-term mortality. Receiver operating characteristic (ROC) curves and Cox analysis were used for the comparison.

Results: Mean follow-up was 56.5 ± 24.6 months. ROC curve analysis showed that the Cockcroft-Gault formula had the greatest accuracy for predicting in-hospital mortality (area under the curve, 0.755; p < 0.001). Multivariate analysis confirmed that the eGFR based on the Cockcroft-Gault formula was an independent predictor of in-hospital (odds ratio, 4.51, p < 0.001) and long-term (hazard ratio, 1.54; p = 0.003) mortality. Both formulas were better than the serum creatinine level.

Conclusions: Both formulas could provide a better measure of risk assessment than serum creatinine for in-hospital and long-term mortality. The Cockcroft-Gault formula was better than the MDRD equation for predicting in-hospital mortality.