Delaying Surgery After PCI Cuts Kidney Injury

“Creatinine levels and AKI are surrogates for bad epiphenomenon” in patients following cardiac surgery. “The kidney is the canary in the mine shaft,” Dr. Kramer said.

It's unclear what it is about scheduling cardiac surgery several days or weeks following coronary catheterization that cuts the risk of AKI. Contrast administered during coronary catheterization “is a major player, but other factors also play a role. It's not that the contrast clears, but contrast causes tubular injury that has to heal and does heal within a few days.” Based on other studies, he speculated that a delay of at least 5 days is ideal.

He cautioned that the finding was limited by the retrospective, single-center nature of the study. But it involved a relatively large number of patients, and creatinine level checks occurred prospectively and uniformly for all patients, eliminating potential ascertainment bias.

Although the findings are just hypothesis generating, Dr. Kramer contended that the findings are compelling enough to warrant an immediate change in practice: Limit cardiac surgery within a few days after catheterization to patients who clearly need rapid intervention.

Disclosures: Dr. Kramer said he had no disclosures relevant to this study.

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