Impact of chronic kidney disease on patients with unprotected left main coronary artery disease treated with coronary artery bypass grafting or drug-eluting stents.
OBJECTIVE
This study aimed to evaluate clinical outcomes after percutaneous coronary intervention with drug-eluting stents (DESs) or coronary artery bypass grafting (CABG) in unprotected left main coronary artery (ULMCA) disease patients with and without chronic kidney disease.


BACKGROUND
The optimal coronary revascularization strategy for ULMCA disease patients with chronic kidney disease remains uncertain.


METHODS
The sample included 818 ULMCA disease patients who received DESs (n=358) or underwent CABG (n=460). We retrospectively compared clinical parameters and outcomes between different endogenous creatinine clearance rates [estimated glomerular filtration rates (eGFRs), ml/min×1.73 m].


RESULTS
The incidences of major adverse cardiocerebral events, all-cause death, cardiac death, and stroke were not significantly different between the DES and the CABG groups. The DES group had significantly higher risks of myocardial infarction (MI) and target vessel revascularization than the CABG group. Compared with the CABG group, the hazard ratios for target vessel revascularization were 3.965 [95% confidence interval (CI): 1.743-9.023, P=0.001] in the eGFR of at least 60 group and 46.463 (95% CI: 4.558-473.639, P=0.001) in the eGFR 45-59 group. The rate of MI was higher in patients treated with DESs in the eGFR of less than 45 group (hazard ratio: 14.098, 95% CI: 1.123-176.988, P=0.040).


CONCLUSIONS
For patients with ULMCA disease at risk of higher repeat revascularization with normal renal function or eGFR of at least 45 ml/min×1.73 m, DESs are a safe alternative to CABG. However, for patients with severely reduced kidney function (eGFR<45 ml/min×1.73 m), DESs should be selected after careful evaluation of MI risk.
Departments of aCardiology bPharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing cDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Yu
Y
Pan
Qi
Q
Qiu
Fang
F
Chen
Xuelian
X
Li
Xianpeng
X
Yu
Yawei
Y
Luo
Quan
Q
Li
Jiqiang
J
He
Yuechun
Y
Gao
Xiaoling
X
Zhang
Xuejun
X
Ren
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D054855:Drug-Eluting Stents; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine