Background: Acute kidney injury (AKI) is a serious complication following coronary revascularization. Diabetes mellitus is a major risk factor for aggressive coronary artery disease. Several studies evaluated PCI and CABG among diabetic patients with multi-vessel CAD, but none compared the two interventions in terms of AKI. This study compared renal outcomes of post-PCI and post-CABG diabetic patients with multi-vessel CAD.
Method: This was a retrospective cohort study conducted at the Philippine Heart Center, employing chart review of previously admitted diabetic patients aged 30 to 80, with multi-vessel CAD and underwent either PCI or CABG at PHC from 2010 to 2012. Diagnosis of AKI was determined based on KDIGO guidelines. Logistic regression and multivariate analyses were used to compare renal outcomes between PCI and CABG. Level of significance was set at 0.05.
Results: A total of 199 subjects comprise the population, which is largely homogeneous, except for the mean age, number of vessel involvement and post-procedural inotropic use. Mean age was 59±9 years for the PCI group and 63±12 years for the CABG group, with male predominance (151/199 or 76%). Majority underwent CABG (123/199 or 62%). Mean eGFR was 74±23 ml/min and 76±20 ml/min for the PCI and CABG group, respectively. The odds of developing AKI is twice higher in multi-vessel CAD patients undergoing CABG versus PCI (p=0.098), and thrice higher post-CABG versus PCI after adjustment for age and history of ACS (p = 0.020).
Conclusion: Diabetic patients with multi-vessel CAD are more likely to develop AKI post-CABG than post-PCI when adjusted for age and prior ACS.