Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of end-stage renal disease (ESRD) is unknown.
This study included 29 330 patients who underwent primary isolated CABG in Sweden between 2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 µmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3.
This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function.
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with early mortality. Its impact on the risk of myocardial infarction (MI) over time and long-term mortality has not been well described.
We performed a nationwide population-based cohort study in 27,929 patients who underwent a first isolated CABG between 2000 and 2008 in Sweden. Acute kidney injury was divided into three categories based on the absolute increase in postoperative serum creatinine (sCr) concentration compared with the preoperative baseline: stage 1, sCr increase of 0.3 to 0.5mg/dL; stage 2, sCr increase of >0.5 to 1.0mg/dL and stage 3, sCr increase of = 1.0mg/dL.
The overall incidence of postoperative AKI was 13%, 6.3% met the criterion for stage 1, 4.3% for stage 2 and 2.3% for stage 3. During a mean follow-up of 5.0 years, there were 2119 (7.6%) MIs and 4679 (17%) deaths. Multivariable adjusted hazard ratios with 95% confidence intervals for MI were 1.35 (1.15 to 1.57), 1.80 (1.53 to 2.13) and 1.63 (1.29 to 2.07), in AKI stages 1, 2 and 3, respectively. The corresponding hazard ratios for all-cause mortality were 1.30 (1.17 to 1.44), 1.65 (1.48 to 1.83) and 2.68 (2.37 to 3.03), respectively.
Our results show that AKI after CABG is associated with an increased long-term risk of MI and death.
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: firstname.lastname@example.org.
Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke.
50,244 patients who underwent coronary artery bypass grafting (CABG) in Sweden between 2000 and 2008 were identified from the SWEDEHEART registry. After exclusions 23,584 patients without prior stroke who underwent elective, primary, isolated, CABG were included. AKI was categorized according to absolute increases in postoperative creatinine values compared with preoperative values: stage 1, 0.3-0.5 mg/dL (26-44 µmol/L); stage 2, 0.5-1.0mg/dL (44-88 µmol/L); and stage 3, >1.0 mg/dL (=88 µmol/L). Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. There were 1156 (4.9%) strokes during a mean follow-up of 4.1 years. After adjustment for confounders, HRs (95% CIs) for stroke in AKI stages 1, 2 and 3 were 1.12 (0.89-1.39), 1.31 (1.04-1.66) and 1.31 (0.92-1.87), respectively, compared with no AKI. This association disappeared after taking death into account in competing risk analysis. There was a significant association between AKI and stroke in men (HR: 1.26 [1.05-1.50]) but not in women (HR: 1.07 [0.75-1.53]), and in younger (
To investigate the prognostic importance of acute kidney injury on early mortality, postoperative stroke, and mediastinitis in patients undergoing a first isolated coronary artery bypass grafting.
7594 patients undergoing coronary artery bypass grafting with information on pre- and postoperative serum-creatinine values were included. Patients were classified using the Acute Kidney Injury Network classification. Odds ratios (OR) for mortality and postoperative complications within 60 days of surgery were calculated after adjustment for confounders separately for stage 1 and for stages 2 and 3 together.
1047 (14%) patients developed acute kidney injury. There were 132 (1.7%) deaths, 103 (1.4%) strokes and 118 (1.6%) cases of mediastinitis during follow-up. Among patients in stage 1 the adjusted odds ratio for death was 4.36 (95% confidence interval 2.83-6.71) and for stage 2 plus 3; 21.5 (12.0-38.6) compared to patients without acute kidney injury. Corresponding OR for stroke were 2.34 (1.43-3.82) and 6.52 (2.97-14.3) and for mediastinitis 2.88 (1.84-4.50) and 4.68 (2.07-10.6), respectively.
Acute kidney injury following coronary artery bypass grafting is related to postoperative mortality, stroke, and mediastinitis. Patients undergoing coronary artery bypass grafting should be assessed for presence of acute kidney injury postoperatively, in order to predict early prognosis.
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is common and increases the risk of postoperative complications and mortality. There is little information on the association between AKI after CABG and long-term risk of incident heart failure (HF).
All patients (n=24 018) undergoing primary, isolated CABG in Sweden between 2000 and 2008 with complete information on pre- and postoperative serum creatinine values, and no prior hospitalization for HF were included. The postoperative increase in serum creatinine was used to define different stages of AKI: stage 1, 0.3 to 0.5 mg/dL; stage 2, 0.5 to 1 mg/dL; stage 3, >1 mg/dL. Hazard ratios with 95% confidence intervals were calculated for first hospitalization for HF for each stage of AKI using Cox proportional hazards regression. Twelve percent of the study population developed AKI. During a mean follow-up of 4.1 years, there were 1325 cases (5.5%) of incident HF. Hazard ratios with 95% confidence interval for HF in AKI stage 1, 2, and 3 were 1.60 (1.34-1.92), 1.87 (1.54-2.27), and 1.98 (1.53-2.57), respectively, after multivariable adjustment for age, sex, diabetes mellitus, estimated glomerular filtration rate, left ventricular ejection fraction, and myocardial infarction before surgery or during follow-up.
AKI is associated with increased long-term risk of HF after CABG. Patients with AKI after CABG should be followed closely to detect early changes in cardiac function.
Depression is common in patients with coronary artery disease and is associated with increased cardiovascular morbidity and mortality. Previous reports on the relationship between antidepressant use before coronary artery bypass grafting (CABG) and survival are conflicting. Our aim was to study the association between preoperative antidepressant use and survival following CABG.
We identified all patients who underwent primary isolated non-emergent CABG in Sweden between 2006 and 2008. We used the SWEDEHEART registry and the Swedish National Patient Register to acquire information about baseline characteristics, and the national Prescribed Drug Register to obtain data regarding exposure, defined as at least one antidepressant prescription dispensed before surgery.
Of the 10,884 patients identified, 1171 (11%) were treated with antidepressants before surgery. Unadjusted 4-year survival was 89% in the antidepressant group compared with 92% in the group without antidepressant use (p=0.002). After multivariable adjustment, antidepressant use was associated with increased mortality (hazard ratio [HR] 1.45; 95% confidence interval [CI] 1.18-1.77), compared with non-use of antidepressants. Antidepressant use was also associated with an increased risk of rehospitalization (HR 1.40; 95% CI 1.19-1.65) and the composite endpoint rehospitalization or death (HR 1.44; 95% CI 1.26-1.65).
Among patients who underwent contemporary primary isolated CABG on a nonemergency basis in Sweden, there was a strong and statistically significant association between antidepressant use prior to surgery and long-term survival.
Congestive heart failure (CHF) is a serious complication in patients with atrial fibrillation (AF).
To study associations between relevant co-morbidities and CHF in patients with AF.
Study population included all adults (n=12,283) =45 years diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios with 95% confidence intervals (CIs) for the associations between co-morbidities, and prevalent CHF. In a subsample (n=9424), (excluding patients with earlier CHF), Cox regression was used to estimate hazard ratios with 95% CIs for the association between co-morbidities, and a first hospital diagnosis of CHF, after adjustment for age and socio-economic factors.
During 5.4 years' follow-up (standard deviation 2.5), 2259 patients (24.0%; 1135 men, 21.8%, and 1124 women, 26.7%) were diagnosed with CHF. Patients with hypertension were less likely to have CHF, while a diagnosis of coronary heart disease, valvular heart disease, diabetes, or chronic obstructive pulmonary disease (COPD), was consistently associated with CHF among men and women. CHF was more common among women with depression. The relative fully adjusted risk of incident CHF was increased for the following diseases in men with AF: valvular heart disease, cardiomyopathy, and diabetes; and for the following diseases in women: valvular heart disease, diabetes, obesity, and COPD. The corresponding risk was decreased among women for hypertension.
In this clinical setting we found hypertension to be associated with a decreased risk of CHF among women; valvular heart disease and diabetes to be associated with an increased risk of CHF in both sexes; and cardiomyopathy to be associated with an increased risk of CHF among men.
Erectile dysfunction (ED) is associated with an increased risk of cardiovascular disease in healthy men. However, the association between treatment for ED and death or cardiovascular outcomes after a first myocardial infarction (MI) is unknown.
In a Swedish nationwide cohort study all men 5 dispensed prescriptions of phosphodiesterase-5 inhibitors was reduced by 34% (HR 0.66 (95% CI 0.38 to 1.15), 53% (HR 0.47 (95% CI 0.26 to 0.87) and 81% (HR 0.19 (95% CI 0.08 to 0.45), respectively, when compared with alprostadil treatment.
Treatment for ED after a first MI was associated with a reduced mortality and heart failure hospitalisation. Only men treated with phosphodiesterase-5 inhibitors had a reduced risk, which appeared to be dose-dependent.
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Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting.
To study the association of donor age and sex with survival of patients receiving transfusions.
A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016.
The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up.
Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression.
Results of a crude analysis including 968?264 transfusion recipients (550?257 women and 418?007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (
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To study association between relevant cardiovascular pharmacotherapy and incident congestive heart failure (CHF) in patients with atrial fibrillation treated in primary health care.
Study population included all adults (n?=?7975) aged 45 years and older diagnosed with atrial fibrillation at 75 primary care centers in Sweden between 2001 and 2007. Outcome was defined as a first diagnosis of CHF post-atrial fibrillation diagnosis. Association between CHF and treatment with relevant cardiovascular pharmacotherapies (beta blockers, calcium blockers, digitalis, diuretics, RAS blockers, and statins) was explored using Cox regression analysis with hazard ratios and 95% CIs. Adjustments were made for age, sociodemographic variables, and comorbid conditions (with or without cardiovascular disorders).
During a mean of 5.7 years (SD 2.3) of follow-up, totally 1552 patients (19.5%; 803 women and 749 men) had a recorded CHF diagnosis. Thiazides (hazard ratio 0.74, 95% CI 0.65-0.84), vessel-active calcium channel blockers (hazard ratio 0.76, 95% CI 0.67-0.86), and nonselective beta blockers (hazard ratio 0.84, 95% CI 0.72-0.98), with specifically sotalol representing 80% of nonselective beta blockers (hazard ratio 0.81, 95% CI 0.69-0.97), were associated with lower CHF risk in fully adjusted models. Loop diuretics (hazard ratio 1.41, 95% CI 1.25-1.57) were associated with a higher risk. Findings for thiazides and vessel-active channel blockers were consistent in the tested subgroups.
In this clinical setting, we found that thiazides, vessel-active calcium channel blockers, and nonselective beta blockers (specifically sotalol) were associated with a lower risk of incident CHF among patients with atrial fibrillation. The findings of the present study need to be confirmed in other settings.