title: An optimal strategy for coronary revascularization in patients with severe renal dysfunction.
abstract: OBJECTIVE
  The optimal strategy for coronary revascularization in patients with renal dysfunction remains undefined. As coronary artery bypass grafting (CABG) may be associated with higher mortality, less invasive percutaneous coronary intervention (PCI) may be preferred. To date, only limited information has been published regarding the effects of severe renal dysfunction on the outcome after CABG and PCI. To address this limitation, we analysed the clinical outcomes after CABG or PCI in patients with severe renal dysfunction not on chronic haemodialysis (HD).
  
  
  METHODS
  Among patients enrolled in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) Registry (a multicentre PCI/CABG registry in Japan), we identified 374 patients with multivessel disease and an estimated glomerular filtration rate <30 ml min(-1)1.73 m(-2) (PCI: n = 229, CABG: n = 145). Patients with acute myocardial infarction (n = 221) were excluded. Then, 77 pairs were selected for further analysis using propensity score matching. The median follow-up was 2.5 years.
  
  
  RESULTS
  In-hospital deaths following CABG (2, 2.6%) and PCI (4, 5.2%) did not differ significantly between groups (P = 0.46). Deterioration of renal function during hospitalization occurred in 9 and 5% of the CABG and PCI groups, respectively (P = 0.35). The rate of early introduction of HD did not differ between groups: CABG, 8%; PCI, 9%. Long-term survival was not different between CABG and PCI. However, freedom from major adverse cardiac and cerebrovascular events (log-rank, P = 0.003) and target lesion revascularization (log-rank, P = 0.003) was markedly higher in CABG.
  
  
  CONCLUSIONS
  Despite the marked progress in PCI technologies and techniques, CABG remains the standard treatment in patients with coronary artery disease complicated by severe renal dysfunction.
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan komiya@kchnet.or.jp.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Ueno
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
authors.affiliation: Division of Cardiovascular Surgery, Faculty of Medicine, Nara Hospital, Kinki University, Nara, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiwaki
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Hanyu
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Marui
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Coronary artery bypass grafts; Renal dysfunction