Comparison of clinical outcomes of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in renal dialysis patients.
BACKGROUND
The leading cause of death in chronic renal dialysis patients is cardiovascular disease. As the number of dialysis patients increases, we are encountering more patients with severe ischemic heart disease requiring coronary intervention.


METHODS
A retrospective analysis was performed of the short- and long-term clinical results in 23 coronary artery bypass grafting patients and 20 coronary angioplasty patients undergoing chronic renal dialysis.


RESULTS
Among coronary bypass grafting patients, there were no hospital deaths. The graft patency rate was 100% for arterial grafts. There were four late deaths and four cardiac events. In coronary angioplasty patients, the lesion success rate was 76%. There were no hospital deaths and three major complications. The restenosis rate was 70%. There were two late deaths and 14 cardiac events. The 5-year cardiac event-free rate was 70% in coronary bypass grafting patients, significantly better than 18% in coronary angioplasty patients (p < 0.001).


CONCLUSIONS
Coronary artery bypass grafting in chronic renal dialysis patients can be accomplished with a better short- and long-term outcome than coronary angioplasty, through an intensive perioperative dialysis program and extensive use of arterial grafts.
Koyanagi
T
T
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Nishida
H
H
Kitamura
M
M
Endo
M
M
Koyanagi
H
H
Kawaguchi
M
M
Magosaki
N
N
Sumiyoshi
T
T
Hosoda
S
S
D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003928:Diabetic Nephropathies / Q000150:complications; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency