title: Early and late outcomes of coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stents for dialysis patients.
abstract: BACKGROUND
  Advances in percutaneous coronary intervention (PCI) using drug-eluting stents (DES) have impacted clinical practice. However, the efficacy of DES for dialysis patients still remains controversial. This study compares the early and long-term clinical outcomes of coronary artery bypass grafting (CABG) and PCI with DES in dialysis patients.
  
  
  METHODS
  A retrospective review was performed in 125 dialysis patients treated between 2004 and 2007. Fifty-eight patients underwent CABG and 67 underwent PCI with DES. The overall death, cardiac death, and cardiac-related event rates were analyzed using the Kaplan-Meier method. For the risk-adjusted comparisons, multivariable logistic and Cox regression analyses were used.
  
  
  RESULTS
  The preoperative characteristics of the patients were similar except for the ejection fraction (p = 0.002) and the number of diseased vessels (p < 0.001). The 30-day mortality was 0 in both groups. The overall survival rates at one, three, and five years were 84.2%, 64.7%, and 56.2% in CABG group and 88.2%, 75.5%, and 61.7% in DES group, respectively (p = 0.202). The rates of freedom from cardiac-related events at one, three, and five years were 76.6%, 68.1%, and 48.6%, and 63.0%, 31.4%, and 0% in CABG and DES groups (p < 0.001), respectively, including seven (10%) late thromboses in the DES group. Although the risk-adjusted analysis showed no significant difference for overall and cardiac death rates, the rates of cardiac-related events and graft/stent failure were significantly higher in the DES group.
  
  
  CONCLUSIONS
  CABG is superior for revascularization in dialysis patients compared with PCI using DES in terms of freedom from cardiac-related events.
authors.affiliation: Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. tsachie@med.nagoya-u.ac.jp
authors.forename: Sachie
authors.initials: S
authors.lastname: Terazawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takami
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tanaka
authors.forename: Noritaka
authors.initials: N
authors.lastname: Okada
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000401:mortality; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome