title: Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI-analysis of routine statutory health insurance data.
abstract: We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy.
  
  
  
  Retrospective analysis of routine statutory health insurance data between 2010 and 2012.
  
  
  
  Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year. Secondary outcomes were repeat revascularisation at 30 days and 1 year and bleeding events within 7 days.
  
  
  
  The total number of cases was n=4123 (PCI; n=3417), median age was 71 (IQR 62-77), 30.4% were women. The adjusted OR for death within 30 days was 0.59 (95% CI 0.43 to 0.81) for patients undergoing PCI versus CABG. At 1 year, the adjusted OR for major adverse cardiac and cerebrovascular events (MACCE) was 1.58 (1.32 to 1.89) for PCI versus CABG and 1.47 (1.23 to 1.75) for all-cause death. In the subgroup of patients with acute myocardial infarction (AMI), adjusted all-cause mortality at 30 days did not differ significantly between both groups (OR 0.75 (0.47 to 1.20)), whereas in patients without AMI the OR for 30-day mortality was 0.44 (0.28 to 0.68) for PCI versus CABG. At 1 year, the adjusted OR for MACCE in patients with AMI was 1.40 (1.06 to 1.85) for PCI versus CABG and 1.47 (1.08 to 1.99) for mortality.
  
  
  
  In this cohort of unselected patients with ESRD undergoing revascularisation, the 1-year outcome was better for CABG in patients with and without AMI. The 30-day mortality was higher in non-AMI patients with CABG reflecting an early hazard with surgery. In cases where the patient's characteristics and risk profile make it difficult to decide on a revascularisation strategy, CABG could be the preferred option.
authors.affiliation: Division of Emergency Medicine and Chest Pain Units, Department of Cardiology , Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: Division of Emergency Medicine and Chest Pain Units, Department of Cardiology , Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.affiliation: Department of Cardiology and Nephrology , Helios Klinikum, Berlin-Buch , Berlin , Germany.
authors.forename: Henning Thomas
authors.initials: HT
authors.lastname: Baberg
authors.affiliation: Medical Service of the Health Funds (MDK) Baden-Württemberg , Lahr , Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Dirschedl
authors.affiliation: German Society of Cardiologists in Private Practise (BNK-Bundesverband niedergelassener Kardiologen) , München , Germany.
authors.forename: Benny
authors.initials: B
authors.lastname: Levenson
authors.affiliation: Federal Association of the Local Health Care Funds (AOK) , Berlin , Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Malzahn
authors.affiliation: Faculty of Economics and Management, Division of Structural Development and Quality Management in Healthcare , Technische Universität Berlin , Berlin , Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mansky
authors.affiliation: Research Institute of the Local Health Care Funds (WIdO) , Berlin , Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Günster
authors.affiliation: Research Institute of the Local Health Care Funds (WIdO) , Berlin , Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Jeschke
keywords: MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD); RENAL DISEASE