Renal dysfunction and long-term risk of heart failure after coronary artery bypass grafting

Martin J Holzmann, Carl Gardell, Anders Jeppsson, Ulrik Sartipy
American Heart Journal 2013, 166 (1): 142-9

BACKGROUND: Renal dysfunction is associated with increased long-term mortality and incidence of myocardial infarction after coronary artery bypass grafting (CABG). The aim was to investigate the relationship between renal dysfunction and long-term risk of heart failure after CABG.

METHODS: All 29,602 patients who underwent primary isolated CABG from 2000 through 2008 in Sweden, with no myocardial infarction within 14 days before surgery, no prior hospitalization for heart failure, and alive 30 days postoperatively, were included from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. Glomerular filtration rates (eGFR) were estimated using the Modification of Diet in Renal Disease equation. Hazard ratios with 95% CIs were calculated for first hospitalization for heart failure.

RESULTS: Mean age in the study population was 67 years, and 20% had eGFR <60 mL/min per 1.73 m(2). During a mean follow-up of 4.5 years, there were 1,690 (5.7%) cases of heart failure. Adjusted hazard ratios with 95% CI for heart failure in patients with eGFR 45 to 60, 30 to 45, and 15 to 30 mL/min per 1.73 m(2) were 1.53 (1.36-1.72), 2.08 (1.76-2.45), and 2.14 (1.52-3.01), respectively, compared with patients with eGFR >60 mL/min per 1.73 m(2).

CONCLUSIONS: Renal dysfunction is a long-term predictor of new-onset heart failure after primary isolated CABG.

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