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Multicenter Study
. 2025 Nov 10;12(2):e003527.
doi: 10.1136/openhrt-2025-003527.

Left main percutaneous or surgical revascularisation and subsequent risk of transient and persistent renal dysfunction

Laura Novelli  1   2 , Jorge Sanz-Sanchez  3   4 , Alessandra Iaccarino  5 , Angelo Oliva  1   2 , Riccardo Terzi  6   7 , Gabriele Luigi Gasparini  2 , Damiano Regazzoli  2 , Antonio Mangieri  2 , Gaia Cantisani  1   2 , Alessandro Barbone  8 , Jose Sorolla Romero  9 , Giuseppe Ferrante  5   10 , Luis Martínez Dolz  11 , Antonio Colombo  5 , Roxana Mehran  12 , Lucia Torracca  8 , Bernhard Reimers  13 , Jose L Luis Diez Gil  14   15 , Giulio Stefanini  10   16 , Mauro Chiarito  17
Affiliations
Multicenter Study

Left main percutaneous or surgical revascularisation and subsequent risk of transient and persistent renal dysfunction

Laura Novelli et al. Open Heart. .

Abstract

Background: Acute kidney injury (AKI) often complicates percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). However, evidence on the incidence and prognostic impact of AKI after revascularisation for left main coronary artery disease (LMCAD) is scant, especially in terms of subsequent risk of persistent renal dysfunction (RD).

Methods: All consecutive patients undergoing PCI or CABG for LMCAD in two European institutions from 2015 to 2022 were enrolled. The coprimary endpoints were AKI, defined as an increase in serum creatinine (sCr) levels ≥0.3 mg/dL or increase by >50% as compared with baseline levels, and persistent RD, defined as a persistent increase of sCr at 1 year. The secondary endpoint was all-cause mortality. The risk of AKI with PCI versus CABG was assessed with multivariable logistic regression and inverse probability of treatment weighting (IPTW). The prognostic impact of transient and persistent RD at 1 year was evaluated with Cox regression analysis.

Results: 1047 patients were included (PCI: 617, CABG: 430). Patients undergoing PCI were older, more often male and affected by chronic kidney disease. AKI occurred in 17% and 28% of patients after PCI and CABG, respectively (adjusted OR 2.82; 95% CI 1.89 to 4.21). Consistent findings were observed after IPTW. AKI was associated with increased 1-year risk of all-cause death, irrespective of revascularisation strategy, but only persistent RD (HR 9.56; 95% CI 4.06 to 22.53) worsened patients' prognosis, unlike AKI with only transient RD (HR 0.65; 95% CI 0.08 to 5.04).

Conclusions: AKI is common after LMCAD revascularisation and occurred more frequently following CABG than PCI. AKI has a substantial prognostic impact irrespective of revascularisation modality, but only when resulting in persistent RD.

Keywords: Coronary Artery Bypass; Coronary Stenosis; Percutaneous Coronary Intervention.

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Conflict of interest statement

Competing interests: GS reports a research grant from Boston Scientific and speaker or consulting fees from B. Braun, Biosensors and Boston Scientific. RM reports grants from Abbott Laboratories, AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers Squibb, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, OrbusNeich; personal fees from Abbott Laboratories, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, PLx Opco Inc/dba PLx Pharma Inc, Roivant Sciences, Sanofi, Medtelligence (Janssen Scientific Affairs), Janssen Scientific Affairs; other from Abbott Laboratories, other from Abiomed, other from Bristol Myers Squibb, other from Claret Medical, other from Elixir Medical, other from The Medicines eCompany, other from Spectranetics/Philips/Volcano Corp, other from Watermark Research Partners; non-financial support and other from Regeneron Pharmaceuticals, Idorsia Pharmaceuticals Ltd. JSS reports personal fees from Medtronic, Boston Scientific, Terumo, Biosensors and a research grant from PRIM.

Figures

Figure 1
Figure 1. Distribution of AKI severity according to KDIGO Classification. AKI, acute kidney injury; CABG, coronary aortic bypass graft; KDIGO, Kidney Disease Improving Global Outcomes; PCI, percutaneous coronary intervention.
Figure 2
Figure 2. Kaplan-Meier curves for all-cause death (A) and MACE (B) in patients with AKI compared with those without AKI. AKI, acute kidney injury; MACE, major adverse cardiovascular events.
Figure 3
Figure 3. Kaplan-Meier for all-cause death (A) and MACE (B) in patients with persistent and transient RD and those who did not experience AKI. MACE, major adverse cardiovascular events; RD, renal dysfunction.
See this image and copyright information in PMC

References

    1. Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol. 2015;40:93–126. doi: 10.1016/j.cpcardiol.2014.11.003. - DOI - PubMed
    1. Stone GW, Kappetein AP, Sabik JF, et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019;381:1820–30. doi: 10.1056/NEJMoa1909406. - DOI - PubMed
    1. Neumann FJ, Sousa-Uva M, Ahlsson A. ‘Ten commandments’ for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur Heart J. 2019;40:79–80. doi: 10.1093/eurheartj/ehy855. - DOI - PubMed
    1. Rydén L, Sartipy U, Evans M, et al. Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease. Circulation. 2014;130:2005–11. doi: 10.1161/CIRCULATIONAHA.114.010622. - DOI - PubMed
    1. Weisbord SD, Palevsky PM. Contrast-induced acute kidney injury: short- and long-term implications. Semin Nephrol. 2011;31:300–9. doi: 10.1016/j.semnephrol.2011.05.009. - DOI - PMC - PubMed

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