• Giovanni Mariscalco, Marzia Cottini, Carmelo Dominici, Maciej Banach, Gabriele Piffaretti, Paolo Borsani, Vito Domenico Bruno, Claudio Corazzari, Riccardo Gherli, and Cesare Beghi.
• Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. Electronic address: giovannimariscalco@yahoo.it.
• Int. J. Cardiol. 2014 Apr 15;173(1):46-54.

BackgroundAcute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive.MethodsA total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis.ResultsPostoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on >1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014).ConclusionsDelaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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