title: Coronary artery bypass grafting and percutaneous coronary intervention in patients with end-stage renal disease.
abstract: OBJECTIVE
  To determine the relative risks of long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among patients with end-stage renal disease (ESRD).
  
  
  METHODS
  We identified 1015 patients with ESRD who underwent coronary revascularization between 1996 and 2008 within Kaiser Permanente Northern California. We obtained clinical variables from health plan databases, state death certificates and social security administration files. Our primary and secondary outcomes, respectively, were all-cause mortality and repeat revascularization. Our primary predictor was CABG compared with PCI. We used a Cox proportional hazards model for multivariable analyses.
  
  
  RESULTS
  The mean age of CABG and PCI patients was similar (64.7 ± 10.6 and 63.4 ± 9.3, respectively, P = 0.06). The CABG group had a higher proportion of diabetics (P = 0.045), and higher nitrate use (P = 0.01). Adjusted for age, gender, race, year of index revascularization, number of vessels intervened, duration of dialysis and baseline comorbidities, patients referred for CABG during the first year had a hazard ratio (HR) of 1.16 [95% confidence interval (CI), 0.80-1.67] for mortality compared with PCI. During Years 1-5, the HR was 0.91 (95% CI, 0.63-1.33) with an overall HR of 0.73 (95% CI, 0.43-1.22). The sub-HR as calculated by the Fine-Gray competing risk model was 0.51 (95% CI, 0.31-0.85).
  
  
  CONCLUSIONS
  As there are no randomized clinical trials in this area, our observational study adds to the growing body of literature that suggests a significant decrease in repeat revascularization with CABG and at least equivalency in long-term mortality with CABG when compared with PCI in ESRD patients.
authors: Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA ashok.krishnaswami@kp.org.
authors: Ashok
authors: A
authors: Krishnaswami
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors: Charles E
authors: CE
authors: McCulloch
authors: Division of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
authors: Magdy
authors: M
authors: Tawadrous
authors: Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA.
authors: James J
authors: JJ
authors: Jang
authors: Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA.
authors: Hon
authors: H
authors: Lee
authors: Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
authors: Vicken
authors: V
authors: Melikian
authors: Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA.
authors: Gennie
authors: G
authors: Yee
authors: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors: Thomas K
authors: TK
authors: Leong
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors: Alan S
authors: AS
authors: Go
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Angioplasty; Chronic kidney disease; Comparative effectiveness; Coronary artery bypass grafting; Coronary revascularization; Dialysis; End-stage renal disease; Percutaneous coronary intervention; Stent