Coronary artery bypass grafting vs. drug-eluting stent implantation in patients with end-stage renal disease requiring dialysis
Open Access
- 1 January 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Renal Failure
- Vol. 42 (1), 107-112
- https://doi.org/10.1080/0886022X.2019.1710187
Abstract
Objectives: To evaluate the optimal revascularization strategy for patients with coronary artery disease (CAD) and end stage renal disease (ESRD) in the drug-eluting stent (DES) era. Methods: One hundred and twelve patients with ESRD treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) were enrolled from 2007 to 2017. All patients were dialysis-dependent, of which 26 received CABG and 86 underwent PCI. The primary endpoint was all-cause mortality. Secondary endpoints were major adverse cardiovascular events including myocardial infarction, stroke, repeat revascularization, and death. Results: The CABG group had a higher prevalence of left main CAD (57.7% vs. 11.6%, p < .01) compared with PCI group. The short-term (within 30 days after the procedure) risk of death was higher in CABG group compared with PCI group (15.4% vs. 1.2%, p < .05). The two groups exhibited similar rate of primary endpoints (50.0% vs. 40.7%, p = .37) and secondary endpoints (65.4% vs. 60.5%, p = .97) in long-term observation. Multivariate Cox regression showed that patients older than 65 or underwent peritoneal dialysis (PD) had significant higher rate of mortality than those under 65 (HR 2.85; 95% CI 1.20–6.85; p < .05) or underwent hemodialysis (HD) (HR 6.69; 95% CI 2.35–19.05; p < .01). Conclusions: Among patients with CAD and dialysis-dependent chronic kidney disease (CKD), treatment with CABG or PCI with DES exhibited similar long-term outcomes. However, CABG was associated with higher short-term risk of death. Higher mortality was revealed in patients over 65 years and underwent PD.Keywords
This publication has 19 references indexed in Scilit:
- Effect of Renin - Angiotensin - Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in KoreaKidney International Reports, 2018
- Comparative Efficacy of Coronary Revascularization Procedures for Multivessel Coronary Artery Disease in Patients With Chronic Kidney DiseaseThe American Journal of Cardiology, 2017
- 2014 ESC/EACTS Guidelines on myocardial revascularizationEuropean Heart Journal, 2014
- Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)The American Journal of Cardiology, 2014
- Long-Term Survival and Repeat Coronary Revascularization in Dialysis Patients After Surgical and Percutaneous Coronary Revascularization With Drug-Eluting and Bare Metal Stents in the United StatesCirculation, 2013
- Multivessel Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in ESRDJournal of the American Society of Nephrology, 2012
- Coronary Artery Bypass Surgery Is Superior to Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Chronic Renal Failure on HemodialysisThe Annals of Thoracic Surgery, 2010
- Perioperative outcomes among patients with end-stage renal disease following coronary artery bypass surgery in the USANephrology Dialysis Transplantation, 2010
- Chronic kidney disease and cardiovascular disease in the Medicare populationKidney International, 2003
- Differential survival after coronary revascularization procedures among patients with renal insufficiencyKidney International, 2001