title: Clinical outcomes of treatment by percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with chronic kidney disease undergoing index revascularization in Ontario.
abstract: BACKGROUND
  There is a paucity of data on the comparative effectiveness of percutaneous coronary intervention using contemporary drug-eluting stent (DES) compared with coronary artery bypass graft (CABG) surgery in patients with chronic kidney disease.
  
  
  RESULTS
  A population-based study was performed using the Cardiac Care Network, a provincial registry of all patients undergoing cardiac catheterization in Ontario, to evaluate patients treated with either percutaneous coronary intervention using DES or CABG between October 1, 2008, and September 30, 2011. Chronic kidney disease was defined as creatinine clearance <60 mL/min. A total of 1786 propensity-matched patients from 4006 patients with chronic kidney disease undergoing index revascularization for multivessel disease with either DES or isolated CABG (n=893 each group) were analyzed. Baseline and procedural characteristics between percutaneous coronary intervention and CABG groups were well-balanced, including urgent revascularization priority, diabetes mellitus, left ventricular function, and 3-vessel disease. The 1-, 2-, and 3-year Kaplan-Meier survival analyses in propensity-matched patients favored CABG (93.2% versus 89.3%; 86.6% versus 80.3%; 80.8% versus 71.5%, respectively; P<0.001). The CABG cohort had greater 1-, 2-, and 3-year freedom from major adverse cardiac and cerebrovascular events (89.4% versus 71.2%; 81.9% versus 60.5%; 75.2% versus 51.8%, respectively; P<0.001). Cox regression analysis identified DES use to be associated with greater hazard for late mortality (hazard ratio, 1.58; 95% confidence interval, 1.32-1.90) and major adverse cardiac and cerebrovascular events (2.62; 2.28-3.01; all P<0.001).
  
  
  CONCLUSIONS
  In this large provincial registry, CABG was associated with improved early and late clinical outcomes when compared with percutaneous coronary intervention using DES in patients with chronic kidney disease undergoing index revascularization.
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Dennis
authors.initials: D
authors.lastname: Ko
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Fremes
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Sanjit
authors.initials: S
authors.lastname: Jolly
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.). vlad.dzavik@uhn.ca.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012424:Rural Population; D016019:Survival Analysis
chemical_list: D003404:Creatinine
keywords: angioplasty; coronary disease; kidney; registries; surgery