Background: Acute kidney injury (AKI) is a serious complication of cardiovascular diseases. Even
a slight increase of serum creatinine (SCr) is associated with a higher risk of mortality,
morbidity, development of chronic kidney disease (CKD) and congestive heart failure
(HF). In patients undergoing coronary artery bypass grafting (CABG) surgery, re-hospitalization
and mortality rates increase among those suffering from postoperative AKI even in
a mild stage as defined by current nephrology (KDIGO) guidelines. Yet, it is unknown
whether AKI predicts re-hospitalization rates in EuroAspire IV patients, surviving
acute myocardial infarction (MI) or acute coronary syndrome (ACS).
Methods: We used data of the German subset (n = 536) of the European wide EUROASPIRE IV multicenter study and all n = 359 patients experiencing ACS or MI during the EUROASPIRE IV index event (October
2011- March 2012) were analyzed. Patients were either treated conservatively, by percutaneous
intervention or by CABG surgery. The KDIGO AKI definition was used to determine the
incidence of AKI - an increase of serum creatinine (SCr) by ≥ 0.3mg/dl within 48hours.
The baseline study visit was performed 6 months to 3 years after the hospital discharge.
Determinants for re-hospitalization between hospital discharge and the study visit
were identified by a multivariate regression model.
Results: AKI occurred in 90 patients (25%) during the index hospitalization. Patients suffering
from AKI tended to be older, were more likely to receive CABG surgery and had a history
of HF (all p < 0.05). CKD at admission and diabetes were no risk factors for AKI during the index
hospital stay (p > 0.05). Between hospital discharge and the study visit, 84 patients were re-hospitalized
due to cardiovascular events, such as myocardial ischemia or infarction, angina, CABG
surgery, PCI, stroke, TIA or due to heart failure. CABG surgery and AKI during index
hospitalization showed an independent association with re-hospitalization until the
follow-up visit (OR(CI95%) 2.35 (1.03–5.36) and 2.03 (1.01–4.05) respectively).
Discussion: In the present cohort, AKI and CABG were independent predictors of re-hospitalization
after a coronary event. Neither age, nor kidney function at hospital admission nor
the history of diabetes were determinants of re-hospitalization.
Conclusion: AKI is an independent risk factor of re-hospitalization in patients hospitalized
for acute coronary syndrome.
