Key result
Higher carotid-femoral PWV linked to ~85% greater AKI risk per 1 m/s after off-pump CABG.
Why the study?
The significance of arterial stiffness and central aortic pressure for predicting acute kidney injury and cardiac events after off-pump CABG needed to be determined.
Do preoperative arterial stiffness and central aortic pressure predict acute kidney injury and cardiac events in patients undergoing off-pump CABG?
Cohort (n=196)
No
Do preoperative arterial stiffness and central aortic pressure predict acute kidney injury and cardiac events in patients undergoing off-pump CABG?
Odds Ratio: 0.846 (95% CI 0.396–0.916)
p-value: p=<0.001
Preoperative assessment of arterial stiffness and central aortic pressure can independently predict the risk of acute kidney injury and adverse cardiac events after off-pump CABG.
May aid perioperative AKI risk stratification after off-pump CABG; hypothesis-generating and requires prospective validation.
Some studies have shown that an increase in arterial stiffness and central aortic pressure increase the risk of postoperative complications for off-pump coronary artery bypass grafting (off-pump CABG). AIM: To determine the significance of arterial stiffness and central aortic pressure indicators for predicting acute kidney injury (AKI) and cardiac events in patients after off-pump CABG. MATERIALS AND METHODS: An analysis of off-pump CABG outcomes was carried out in 196 patients (mean age 62.7 ± 5.3 years) without clinical signs of chronic kidney disease. The patients were divided into a test (n = 56) and control (n = 140) groups, depending on the presence or absence of AKI, acute coronary syndrome (ACS), or cardiac arrhythmias in the early postoperative period. Pulse wave velocity indicators (PWV) were processed on the carotidfemoral (cf PWV) and brachio-ankle (baPWV) segments, and the results of measuring central aortic pressure (CAP). RESULTS: It has been proven that the incidence of AKI is significantly higher in patients with higher cf PWV (n <0.001), baPWV (n = 0.034) and systolic aortic pressure (SAP) (n = 0.013). ACS was more often observed in patients with higher SAP (n <0.001) and diastolic (DAP) (n = 0.005) aortic pressure, and cardiac arrhythmias in patients with higher SAP and office systolic pressure (n < 0.001). Based on the results of logistic regression analysis, it was determined (by regression coefficients — B) that an increase in cf PWV by 1 m/s increases the risk of AKI by 85.0%. An increase in SAP by one unit significantly increases the risk of ACS by 111.0% and cardiac arrhythmias by 58.0%. It was shown that the measurement of CAP has a greater diagnostic value than the office measurement of blood pressure. CONCLUSION: Arterial stiffness is an independent predictor of AKI for off-pump CABG. A decrease in PWV value is accompanied by a decrease in the incidence of AKI. CAP indices have a more significant prognostic value with respect to the likelihood of cardiac events after an off-pump CABG than the data of measurement of blood pressure.
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Туровец et al. (2021) conducted a cohort in Coronary artery disease (n=196). Arterial stiffness (pulse wave velocity) and central aortic pressure vs. Lower arterial stiffness and central aortic pressure was evaluated on Acute kidney injury (AKI) (OR 0.846, 95% CI 0.396-0.916, p=<0.001). An increase in carotid-femoral pulse wave velocity by 1 m/s was associated with an 85.0% increased risk of acute kidney injury following off-pump coronary artery bypass grafting.
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