Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary artery disease and diabetic nephropathy: a single center experience.
BACKGROUND
Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD.


METHODS
The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed.


RESULTS
The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046).


CONCLUSIONS
The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.
Bae
Ki Sun
KS
Department of Internal Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Park
Hyeong Cheon
HC
Kang
Byung Seung
BS
Park
Jong Won
JW
Chon
Nu Ri
NR
Oh
Kyung Jin
KJ
Yoon
Young Won
YW
Hong
You Sun
YS
Ha
Sung Kyu
SK
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome