Abstract
BackgroundSerum phosphorus is a well-known marker of vascular calcification, but the effects of serum phosphorus abnormalities defined by clinical criteria on the outcomes of coronary artery bypass grafting (CABG) remain unclear. We aimed to evaluate whether preoperative serum phosphorus abnormalities defined based on clinical criteria are associated with outcomes of CABG using a relatively new statistical technique, inverse probability weighting (IPW) adjustment.MethodsFrom January 2001 to December 2014, 4,989 consecutive patients who underwent CABG were stratified into normal (2.5–4.5 mg/dl; n = 4,544), hypophosphatemia (<2.5 mg/dl; n = 238), or hyperphophatemia (>4.5 mg/dl; n = 207) groups depending on preoperative serum phosphorus level.ResultsThe primary outcome was all-cause death during a median follow-up of 48 months. Secondary outcomes were cardiovascular death, graft failure, myocardial infarction, repeat revascularization, and stroke. In multivariate Cox analysis, preoperative hypophosphatemia was significantly associated with all-cause death (hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.13–2.76; P = 0.01). However, this association varied depending on chronic kidney disease and emergent operation (p for interaction = 0.05 and 0.03, respectively). In addition, analysis after IPW adjustment demonstrated that preoperative serum phosphorus abnormalities were not significantly associated with all-cause death (P = 0.08) or any secondary outcomes except graft failure. Graft failure was significantly associated with preoperative hypophosphatemia (HR 2.51; 95% CI 1.37–4.61; P = 0.003).ConclusionOur study showed that preoperative serum phosphorus abnormalities in clinical criteria were not associated with outcomes after CABG except for graft failure. And, the association of hypophosphatemia with graft failure remains to be evaluated.
Highlights
Serum phosphorus plays a pivotal role in various biologic processes including energy production, membrane transport, and cellular signaling [1]
In multivariate Cox analysis, preoperative hypophosphatemia was significantly associated with all-cause death
This association varied depending on chronic kidney disease and emergent operation (p for interaction = 0.05 and 0.03, respectively)
Summary
Serum phosphorus plays a pivotal role in various biologic processes including energy production, membrane transport, and cellular signaling [1]. Considering that serum phosphorus is a well-known marker of vascular calcification and an assay is readily available, the effect of preoperative serum phosphorus abnormalities defined based on clinical criteria on the outcomes of CABG need to be re-evaluated. In the present study, we evaluated whether preoperative serum phosphorus abnormalities are related to outcomes of CABG using the definition of serum phosphorus abnormalities from clinical criteria and a relatively new statistical technique, inverse probability weighting (IPW) adjustment. Serum phosphorus is a well-known marker of vascular calcification, but the effects of serum phosphorus abnormalities defined by clinical criteria on the outcomes of coronary artery bypass grafting (CABG) remain unclear. We aimed to evaluate whether preoperative serum phosphorus abnormalities defined based on clinical criteria are associated with outcomes of CABG using a relatively new statistical technique, inverse probability weighting (IPW) adjustment
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