title: Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease.
abstract: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent. The rates of 30-day and long-term mortality, 30-day major adverse cardiovascular events, and hemodialysis dependence after revascularization were compared between these 2 groups by computing the hazard ratios from a Cox proportional hazards model and adjusting them for the baseline covariates and propensity score. After either CABG or PCI, 2.4% of the patients with non-HD CKD were hemodialysis dependent. Compared to PCI, CABG was associated with postoperative hemodialysis dependence (odds ratio 3.2, 95% confidence interval 1.1 to 9.3; p <0.001). However, among patients with non-HD CKD and 3-vessel CAD, those who underwent CABG tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61, 95% confidence interval 0.36 to 1.03; p = 0.06). In the patients with non-HD CKD treated for 2-vessel CAD, those who underwent CABG or PCI had a similar long-term mortality risk (hazard ratio 1.12, 95% confidence interval 0.52 to 2.34; p = 0.7). In conclusion, in patients with non-HD CKD and multivessel CAD, CABG led to better survival than PCI with drug-eluting stents, but CABG patients had a greater short-term risk of requiring permanent hemodialysis.
authors.affiliation: Division of Cardiology, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors.forename: Guha
authors.initials: G
authors.lastname: Ashrith
authors.forename: Vei-Vei
authors.initials: VV
authors.lastname: Lee
authors.forename: Macarthur A
authors.initials: MA
authors.lastname: Elayda
authors.forename: Ross M
authors.initials: RM
authors.lastname: Reul
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome