title: Long-term clinical outcome after surgical or percutaneous coronary revascularization in hemodialysis patients.
abstract: BACKGROUND
  Although revascularization via coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) has been widely performed, there are limited data on which procedure is best in hemodialysis (HD) patients.
  
  
  RESULTS
  This 10-year follow-up study consisted of 997 HD patients electively undergoing coronary revascularization (CABG, n=210; PCI, n=787). With an adjustment for propensity scores with all baseline covariates, the incidence of major adverse cardiac events (MACE) was evaluated as a composite endpoint including all-cause death, non-fatal myocardial infarction (MI) and any revascularization. During the follow-up period, 465 MACE (death, n=325; non-fatal MI, n=45; revascularization, n=274) occurred. The 10-year freedom from MACE was higher in the CABG group compared to the PCI group (51.0% vs. 34.8%, adjusted hazard ratio [HR], 0.64; 95% confidence interval [CI]: 0.49-0.82, P=0.0003). On landmark analysis, adjusted HR of death was higher during the first 6 months after CABG compared to PCI (1.72; 95% CI: 1.04-2.79, P=0.036), but lower from 6 months onward (0.69; 95% CI: 0.48-0.97, P=0.033). When compared to patients treated with drug-eluting stent alone (n=345) in the PCI group, the CABG group still had an advantage for any revascularization (adjusted HR, 0.38; 95% CI: 0.22-0.62, P<0.0001), but not for MACE (adjusted HR, 0.86; 95% CI: 0.64-1.15, P=0.33).
  
  
  CONCLUSIONS
  CABG was totally clinically advantageous compared to PCI in HD patients.
authors: Department of Cardiovascular Surgery, Matsunami General Hospital.
authors: Yoshitaka
authors: Y
authors: Kumada
authors: Hideki
authors: H
authors: Ishii
authors: Toru
authors: T
authors: Aoyama
authors: Daisuke
authors: D
authors: Kamoi
authors: Yoshihiro
authors: Y
authors: Kawamura
authors: Takashi
authors: T
authors: Sakakibara
authors: Haruhiko
authors: H
authors: Nogaki
authors: Hiroshi
authors: H
authors: Takahashi
authors: Toyoaki
authors: T
authors: Murohara
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors