Preoperative renal dysfunction and mortality after off-pump coronary artery bypass grafting in Japanese

Abstract

Background: The purpose of this study was to compare hospital outcomes and long-term survival in Japanese patients with or without renal dysfunction and to estimate the risk of renal dysfunction for survival after isolated off-pump coronary bypass grafting (CABG). Methods and Results: Among 661 consecutive Japanese patients undergoing isolated CABG (656 by the off-pump technique), after exclusion of 51 patients managed with chronic dialysis and 5 patients being revascularized using cardiopulmonary bypass, data from 605 patients were included in the present study. The 30-day mortality was 2.7%, 2.5%, and 0.7% in patients with a glomerular filtration rate (GFR) <30, 30-60, and >60 ml·min-1·1.73 m-2 (P=0.173). Mean follow-up period was 3.4±1.8 years. The 5-year survival free from overall death was 77%, 82%, and 93% in patients with a GFR <30, 30-60, and >60 ml·min-1·1.73 m-2 (P=0.002). Similarly, the 5-year survival free from cardiovascular death was 82%, 86%, and 97%, respectively (P=0.001). Multivariate Cox model identified GFR as a risk factor of overall death (hazard ratio, 0.82 per 10-ml·min-1·1.73 m-2 increase, 95% confidence interval, 0.70-0.95, P=0.008) and cardiovascular death (hazard ratio, 0.70 per 10-ml·min-1·1.73 m-2 increase, 95% confidence interval, 0.57-0.85, P=0.001). Conclusions: Off-pump CABG has a relatively low 30-day mortality in patients with renal dysfunction, but preoperative renal dysfunction is an independent risk factor of long-term survival after isolated off-pump CABG in Japanese patients.