title: Risks of death and end-stage renal disease after surgical compared with percutaneous coronary revascularization in elderly patients with chronic kidney disease.
abstract: OBJECTIVE
  Revascularization by coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is frequently deferred in patients with chronic kidney disease (CKD) to avoid precipitating end-stage renal disease (ESRD), but reliable estimates of absolute and relative risks of death and ESRD after CABG and PCI are unavailable.
  
  
  RESULTS
  CKD patients undergoing CABG (n=4547) or PCI (n=8620) were identified and tracked using the 5% Medicare sample. The cumulative incidence of ESRD and death were reported for observed events. A Cox model with the Fine-Gray method was used to account for competing risks in assessing relative hazards of death and ESRD. Three-year cumulative incidence of ESRD was lower (CABG, 6.8%; PCI, 5.4%) than death (CABG, 28.3%; PCI, 32.8%). The adjusted hazard ratio of death was higher during the first 3 months after CABG than after PCI (1.25; 95% confidence interval, 1.12-1.40; P<0.001), but lower from 6 months onward (0.61; 95% confidence interval, 0.55-0.69). Conversely, risk of ESRD after CABG was higher during the first 3 months (1.59; 95% confidence interval, 1.27-2.01; P<0.001), but was not statistically significant from 3 months onward. The adjusted hazard ratio of combined death or ESRD was similar to death.
  
  
  CONCLUSIONS
  Among CKD patients undergoing coronary revascularization, death is more frequent than ESRD. The incidence of ESRD was lower throughout follow-up after PCI, but long-term risks of death or combined death and ESRD were lower after CABG. Our data suggest better overall clinical outcomes with CABG than with PCI in CKD patients.
authors.affiliation: Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Charytan
authors.forename: Shuling
authors.initials: S
authors.lastname: Li
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012306:Risk; D012494:Sampling Studies; D015607:Stents; D014481:United States