title: Temporal trends in mortality after coronary artery revascularization in patients with end-stage renal disease.
abstract: BACKGROUND
  Recent studies that have assessed the comparative effectiveness between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with end-stage renal disease (ESRD) that have included analyses of temporal trends in mortality have noted mixed results.
  
  
  METHODS
  We conducted an observational longitudinal cohort study of all adults with ESRD undergoing CABG or PCI within Kaiser Permanente Northern California. The primary predictor, index period of revascularization, was categorized into 3 periods: 1996-1999 (reference), 2000-2003, and 2004-2008, with the primary outcome being 3-year all-cause mortality. A multivariable Cox regression model with the assumption of independent censoring was used to determine the adjusted relative risk of the primary predictor.
  
  
  RESULTS
  Among 1015 ESRD patients, 3-year mortality showed no significant change in the 2000-2003 period but was lower during the 2004-2008 period with an adjusted hazard ratio of 0.66 (95% confidence interval: 0.49-0.88; trend test p = 0.01). No change in 30-day mortality was noted. Further adjustment for receipt of medications at baseline and after revascularization did not materially affect risk estimates. No significant interactions were observed between the type of revascularization (CABG or PCI) and the period of the index revascularization.
  
  
  CONCLUSIONS
  Among a high-risk cohort of patients with ESRD and coronary artery disease within Kaiser Permanente Northern California who were referred for coronary revascularization by either CABG or PCI, the relative risk of mortality in the 2004-2008 period decreased by 34% compared with the 1996-1999 period, with the benefit primarily in the decrease in late mortality.
authors.affiliation: Cardiologist at the San Jose Medical Center in CA. ashok.krishnaswami@kp.org.
authors.forename: Ashok
authors.initials: A
authors.lastname: Krishnaswami
authors.affiliation: Consulting Data Analyst at the Division of Research in Oakland, CA. thomas.k.leong@kp.org.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Leong
authors.affiliation: Cardiologist and Professor of Health Research and Policy at Stanford University in CA. mah@stanford.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.affiliation: Nephrologist at Stanford University in CA. tichang@stanford.edu.
authors.forename: Tara I
authors.initials: TI
authors.lastname: Chang
authors.affiliation: Chair of the Cardiovascular and Metabolic Conditions Section and Director of the Comprehensive Clinical Research Unit at the Division of Research in Oakland, CA. alan.s.go@kp.org.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D016019:Survival Analysis
references.citation: JAMA. 2006 Sep 20;296(11):1377-84
references.pmid: 16985230
references.citation: N Engl J Med. 2004 Sep 23;351(13):1296-305
references.pmid: 15385656
references.citation: Am J Public Health. 1992 May;82(5):703-10
references.pmid: 1566949
references.citation: JACC Cardiovasc Interv. 2010 Feb;3(2):172-9
references.pmid: 20170874
references.citation: Circulation. 2013 May 7;127(18):1861-9
references.pmid: 23572500
references.citation: J Am Coll Cardiol. 2003 Jul 16;42(2):201-8
references.pmid: 12875751
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):607-15
references.pmid: 20031899
references.citation: N Engl J Med. 2010 Jun 10;362(23):2155-65
references.pmid: 20558366
references.citation: Kidney Int. 2005 Aug;68(2):818-25
references.pmid: 16014061
references.citation: Circulation. 2010 Jun 22;121(24):2635-44
references.pmid: 20529997
references.citation: Am J Cardiol. 2011 Mar 1;107(5):668-74
references.pmid: 21247541
references.citation: J Am Coll Cardiol. 2009 Jun 9;53(23):2129-40
references.pmid: 19497438
references.citation: N Engl J Med. 2002 Dec 19;347(25):2010-9
references.pmid: 12490682
references.citation: N Engl J Med. 2005 Jul 21;353(3):238-48
references.pmid: 16034009
references.citation: Nephrol Dial Transplant. 2010 Jul;25(7):2275-83
references.pmid: 20103500
references.citation: JAMA. 2011 Jan 26;305(4):381-90
references.pmid: 21266685
references.citation: Arch Intern Med. 2008 Dec 8;168(22):2415-21
references.pmid: 19064823
references.citation: Circulation. 2012 Jan 3;125(1):e2-e220
references.pmid: 22179539
references.citation: J Am Soc Nephrol. 2012 Dec;23(12):2042-9
references.pmid: 23204445
references.citation: Drug Saf. 2000 May;22(5):350-60
references.pmid: 10830252
references.citation: Circ Cardiovasc Interv. 2009 Feb;2(1):6-13
references.pmid: 20031687
references.citation: Clin Epidemiol. 2012;4:115-23
references.pmid: 22701091