Angiographic coronary diffuseness and outcomes in dialysis patients undergoing coronary artery bypass grafting surgery.

Abstract

Pre-operative dialysis-dependent renal failure (DDRF) is a predictor of morbidity and mortality following coronary artery bypass grafting surgery (CABG). Whether this is due in part to a more diffuse coronary atherosclerotic burden in these patients is unknown. The purpose of this study was to compare coronary atherosclerotic disease burden in patients with and without pre-existing DDRF undergoing CABG. From a retrospective analysis of a single-centre cardiac surgical database, consecutive DDRF patients undergoing isolated CABG (n=35) were matched to 70 non-dialysis-dependent (NDD) patients without renal failure by procedure, age, sex, functional status, ejection fraction, number of diseased vessels, and diabetes. Pre-operative angiograms were analyzed by a single, blinded adjudicator using a modification of a previously published coronary diffuseness score (range: 0-45). Angiographic scores and baseline and outcome characteristics were compared using chi(2) tests, Fisher's Exact tests, and t-tests as appropriate. No statistical differences were found among pre-operative characteristics between the two groups. The mean angiographic coronary diffuseness scores for the dialysis and non-dialysis groups were 18.2 and 20.6, respectively (p=0.13). Transfusion was more frequent (77 vs. 23%, p<0.0001) and median length of stay longer (9 vs. 7 days, p=0.02) in the DDRF group. There were no differences in the number of distal anastomoses performed in the two groups. Low rates of peri-operative myocardial infarction, stroke, re-operation, and in-hospital mortality were observed in both groups. Objective quantification revealed that patients with DDRF undergoing CABG did not have a greater coronary artery atherosclerosis disease burden than matched controls who did not have pre-operative DDRF. This may be due to pre-operative patient selection bias. The increased morbidity and mortality of CABG in patients with DDRF is more likely to be due to the multiple adverse systemic effects of renal failure and dialysis on the cardiovascular system as opposed to diffuseness of distal coronary disease.