title: Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention.
abstract: BACKGROUND
  Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD).
  
  
  RESULTS
  8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 (n=1678:839), 30-59 mL/min/1.73 m2 (n=452:226) and <30 mL/min/1.73 m2 (n=74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI)<24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p=0.84, 12.8% vs. 17.3% p=0.12, and 23.0% vs. 40.5% p=0.05 in the three strata, respectively. In patients with eGFR≥60 mL/min/1.73 m2, long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p=0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m2, there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p=0.001). In patients with eGFR<30 mL/min/1.73 m2, there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p=0.17).
  
  
  CONCLUSIONS
  Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors: Hariharan
authors: H
authors: Sugumar
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors: Terase F
authors: TF
authors: Lancefield
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Nick
authors: N
authors: Andrianopoulos
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors: Stephen J
authors: SJ
authors: Duffy
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors: Andrew E
authors: AE
authors: Ajani
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors: Melanie
authors: M
authors: Freeman
authors: Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors: Brian
authors: B
authors: Buxton
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Angela L
authors: AL
authors: Brennan
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; Department of Cardiology, Prince of Wales Hospital, Hong Kong, China.
authors: Bryan P
authors: BP
authors: Yan
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Diem T
authors: DT
authors: Dinh
authors: Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.
authors: Julian A
authors: JA
authors: Smith
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors: Kerrie
authors: K
authors: Charter
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors: Omar
authors: O
authors: Farouque
authors: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Christopher M
authors: CM
authors: Reid
authors: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia. Electronic address: clarkdavidj@hotmail.com.
authors: David J
authors: DJ
authors: Clark
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D012042:Registries
keywords: Angioplasty; Coronary disease; Kidney; Revascularization; Surgery