Safety of same-day coronary angiography in patients undergoing elective aortic valve replacement.

Abstract

BACKGROUND:

Coronary artery imaging is required for most adult patients undergoing aortic valve replacement (AVR).

METHODS:

Between January 1, 2000, and December 31, 2007, 1413 patients underwent elective AVR at Mayo Clinic. Two propensity-matched groups at low risk for acute kidney injury were created: 321 patients with coronary angiography on the same day as AVR (same day) and 321 patients with coronary angiography more than 1 day before AVR (non-same day). We defined acute postoperative kidney injury with Acute Kidney Injury Network criteria (≥0.3 mg/dL or a 50% increase in serum creatinine from baseline).

RESULTS:

The same-day vs non-same-day groups were comparable in age (mean [SD] years: 70.6 [11.0] vs 70.8 [11.5]), sex (111 women [34.6%] vs 114 women [35.5%]), preoperative serum creatinine (1.14 [0.22] vs 1.15 [0.23] mg/dL), and ejection fraction (0.62 [0.12] vs 0.61 [0.12]). Coronary artery revascularization was performed in 118 patients (36.8%) in the same-day group and in 123 (38.3%) in the non-same-day group (p=0.68). Maximum (30-day) postoperative serum creatinine levels were not significantly different between the same-day and non-same day groups (1.30 [0.43] mg/dL vs 1.29 [0.42] mg/dL; p=0.87). Perioperative (30-day) acute kidney injury occurred in 75 patients (23.4%) in the same-day group and in 71 (22.3%) in the non-same-day group (p=0.99). Perioperative (30-day) death occurred in 5 patients (1.6%) in the same-day group and in 7 (2.2%) in the non-same-day group (p=0.56). Other nonfatal complications rates were comparable between groups.

CONCLUSIONS:

In properly selected patients, coronary angiography can be performed the same day as elective AVR with no increase in perioperative morbidity or death.

• Authors: Kevin L Greason, Lars Englberger, Rakesh M Suri, Soon J Park, Charanjit S Rihal, Sorin V Pislaru, Hartzell V Schaff
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 91 Issue 6 Pg. 1791-6 (Jun 2011) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 21619975 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Creatinine

Topics

• Acute Kidney Injury (etiology)
• Aged
• Aortic Valve (surgery)
• Coronary Angiography (adverse effects)
• Creatinine (blood)
• Elective Surgical Procedures
• Female
• Heart Valve Prosthesis Implantation (adverse effects)
• Humans
• Male
• Middle Aged