Effect of Preoperative Creatinine Levels on Mortality after Coronary Artery Bypass Grafting Surgery: an Observational Study

Introduction: Renal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor. Objective: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients. Methods: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in Sao Jose do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 <= AC < 1.0 mg/dL; QII: 1.0 <= AC < 1.2 mg/dL; QIII: 1.2 <= AC < 1.4 mg/dL; and QIV: 1.4 <= AC <= 2.6 mg/dL). Seven risk factors were then evaluated in each stratum. Results: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (>= 65 years) and cardiopulmonary bypass (CPB) time (>= 115 minutes) in QIV, as well preoperative hospital stay (>= 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intraaortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups. Conclusion: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.