title: Assessing the economic attractiveness of coronary artery revascularization in chronic kidney disease patients.
abstract: Chronic kidney disease (CKD) is associated with increased morbidity and mortality in coronary artery disease (CAD) patients. We compared the economic attractiveness of CAD revascularization procedures in patients with and without CKD. Our population included 6218 patients with significant CAD undergoing cardiac catheterization at Duke University between 1996 and 2001, with follow-up through 2002. We investigated the influence of CKD (creatinine clearance < 60 mL/min) upon 3-year survival and medical costs in our CAD population. Coronary artery bypass graft (CABG) surgery was an economically attractive alternative vs. percutaneous coronary intervention (PCI) or medical therapy for all patients with left main disease, three-vessel CAD patients without CKD, and two-vessel CAD patients with CKD. Medical therapy was an economically attractive strategy vs. CABG surgery or PCI for three-vessel CAD patients with CKD, two-vessel CAD patients without CKD, and all single-vessel CAD patients.
authors.affiliation: Duke University Medical Center, Durham, NC 27715, USA. eric.eisenstein@duke.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Jie L
authors.initials: JL
authors.lastname: Sun
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: DeLong
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Szczech
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000652:urine; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000191:economics*; D009657:North Carolina / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000191:economics* / Q000652:urine; D016019:Survival Analysis
chemical_list: D003404:Creatinine
references.citation: N Engl J Med. 1997 Jan 9;336(2):92-9
references.pmid: 8988886
references.citation: Circulation. 2004 May 18;109(19):2290-5
references.pmid: 15117846
references.citation: N Engl J Med. 1996 Jul 25;335(4):217-25
references.pmid: 8657237
references.citation: Circulation. 1994 May;89(5):2015-25
references.pmid: 8181125
references.citation: Circulation. 1979 Dec;60(6):1259-69
references.pmid: 498451
references.citation: Circulation. 2001 Jun 19;103(24):3019-41
references.pmid: 11413094
references.citation: Biometrics. 2001 Dec;57(4):1207-18
references.pmid: 11764262
references.citation: Am Heart J. 2004 Mar;147(3):449-56
references.pmid: 14999193
references.citation: Circulation. 1995 Nov 15;92(10):2831-40
references.pmid: 7586249
references.citation: Arch Intern Med. 1975 Aug;135(8):1017-24
references.pmid: 1156062
references.citation: Circulation. 1999 Sep 28;100(13):1464-80
references.pmid: 10500052
references.citation: BMJ. 2000 Jul 8;321(7253):73-7
references.pmid: 10884254
references.citation: Circulation. 2002 May 14;105(19):2253-8
references.pmid: 12010906
references.citation: Lancet. 1994 Aug 27;344(8922):563-70
references.pmid: 7914958
references.citation: Med Care. 2001 Aug;39(8):824-35
references.pmid: 11468501
references.citation: Circulation. 2003 Nov 18;108(20):2439-45
references.pmid: 14623791
references.citation: Am J Cardiol. 1995 Dec 1;76(16):1177-82
references.pmid: 7484906
references.citation: JAMA. 1989 Apr 14;261(14):2077-86
references.pmid: 2784512
references.citation: Circulation. 1994 Nov;90(5 Pt 2):II124-8
references.pmid: 7955238
references.citation: Circulation. 2002 Jul 30;106(5):626-30
references.pmid: 12147547
references.citation: J Am Coll Cardiol. 1999 Jan;33(1):63-72
references.pmid: 9935010
references.citation: N Engl J Med. 2002 Jun 6;346(23):1773-80
references.pmid: 12050336
references.citation: Kidney Int. 2001 Jul;60(1):292-9
references.pmid: 11422764
references.citation: J Thorac Cardiovasc Surg. 1996 May;111(5):1013-25
references.pmid: 8622299
references.citation: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
references.pmid: 11904577
references.citation: J Am Soc Nephrol. 2003 Sep;14(9):2373-80
references.pmid: 12937316