title: Mode of Coronary Revascularization and Short term Clinical Outcomes in Patients with Chronic Kidney Disease.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients.
  
  
  METHODS
  In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction (MI), or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes.
  
  
  RESULTS
  Out of 159 patients with CKD, 85 (53.5%) received PCI and 74 (46.5%) received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD.
  
  
  CONCLUSIONS
  Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD.
authors: Ashique Ali Khoso, Senior Instructor, Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors: Ashique Ali
authors: AA
authors: Khoso
authors: Khawar Abbas Kazmi, Professor and Section Head of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors: Khawar Abbas
authors: KA
authors: Kazmi
authors: Saqiba Tahir, Medical Student, Aga Khan University, Karachi, Pakistan.
authors: Saqiba
authors: S
authors: Tahir
authors: Hasanat Sharif, Associate Professor and Section Head of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan.Department of Surgery, Aga Khan University Hospital.
authors: Hasanat
authors: H
authors: Sharif
authors: Safia Awan, Statistician, Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors: Safia
authors: S
authors: Awan
keywords: Chronic kidney disease; Coronary artery bypass graft; Coronary revascularization; Creatinine clearance; Percutaneous coronary intervention