title: Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery.
abstract: BACKGROUND
  Randomized trials of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) routinely exclude patients with chronic kidney disease (CKD).
  
  
  OBJECTIVE
  This study evaluated outcomes of PCI versus CABG in patients with CKD.
  
  
  METHODS
  Patients with CKD who underwent PCI using everolimus-eluting stents were propensity-score matched to patients who underwent isolated CABG for multivessel coronary disease in New York. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization.
  
  
  RESULTS
  Of 11,305 patients with CKD, 5,920 patients were propensity-score matched. In the short term, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.35 to 0.87), stroke (HR: 0.22; 95% CI: 0.12 to 0.42), and repeat revascularization (HR: 0.48; 95% CI: 0.23 to 0.98) compared with CABG. In the longer term, PCI was associated with a similar risk of death (HR: 1.07; 95% CI: 0.92 to 1.24), higher risk of MI (HR: 1.76; 95% CI: 1.40 to 2.23), a lower risk of stroke (HR: 0.56; 95% CI: 0.41 to 0.76), and a higher risk of repeat revascularization (HR: 2.42; 95% CI: 2.05 to 2.85). In the subgroup with complete revascularization with PCI, the increased risk of MI was no longer statistically significant (HR: 1.18; 95% CI: 0.67 to 2.09). In the 243 matched pairs of patients with end-stage renal disease on hemodialysis, PCI was associated with significantly higher risk of death (HR: 2.02; 95% CI: 1.40 to 2.93) and repeat revascularization (HR: 2.44; 95% CI: 1.50 to 3.96) compared with CABG.
  
  
  CONCLUSIONS
  In patients with CKD, CABG is associated with higher short-term risk of death, stroke, and repeat revascularization, whereas PCI with everolimus-eluting stents is associated with a higher long-term risk of repeat revascularization and perhaps MI, with no long-term mortality difference. In the subgroup on dialysis, the results favored CABG over PCI.
authors.affiliation: New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: School of Public Health, State University of New York at Albany, Albany, New York.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Samadashvili
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: School of Public Health, State University of New York at Albany, Albany, New York.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors
chemical_list: D000068338:Everolimus
keywords: chronic kidney disease; multivessel disease; percutaneous coronary intervention