Risk Predictors Analysis That Impact Long-term Outcomes In Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting
Aleksander Dokollari1, Serge Sicouri2, Basel Ramlawi1, Leila Hosseinian1, Francis Sutter1, Gianluca Torregrossa1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Institute for Medical Research, Wynnewood, PA, USA.
BACKGROUND: The main goal of this manuscript is to identify preoperative risk predictors that influences long-term clinical outcomes in patients with chronic kidney disease (CKD) undergoing coronary artery bypass grafting (CABG).
METHODS: This is a propensity-score adjusted analysis of consecutive patients undergoing isolated CABG between May 2005 and June 2021 at our institute. Four models were evaluated for the following long-term outcomes: all-cause mortality, MACCE, stroke, myocardial infarction, angina, and reoperation. Only patients undergoing isolated CABG were included. CKD patients were defined as those with a creatinine clearance < 60 ml/min/1.73 m2.
RESULTS: A total of 4.871 consecutive patients underwent CABG at our institution. Of these, 1.452 patients were included in the CKD group and 3.419 in the non-CKD group. Mean follow-up time was 4-years. Long-term outcomes determined that radial artery graft use has a lower hazard ratio for mortality in patients with CKD (HR 0.8 (0.5, 1.4)) compared to the reference non-CKD group. In addition, patients with CKD and one of the following preoperative risk factors; diabetes, dialysis, chronic obstructive pulmonary disease, STS score > 4%, peripheral vascular disease, low ejection fraction (< 50%), male sex, atrial fibrillation and white race, had a higher hazard ratio for mortality compared to the reference non-CKD group. CKD patients had a significantly higher rate of mortality (20.4% vs 7.8%, p<.001) compared to non-CKD patients.
CONCLUSIONS: We found new risk predictors for mortality that impact long-term prognosis in patients with CKD undergoing CABG. 
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