Tags

Type your tag names separated by a space and hit enter

Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS).
Am Heart J. 2005 Mar; 149(3):512-9.AH

Abstract

BACKGROUND

Chronic kidney disease (CKD) is associated with adverse outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI), but it is unclear which of these revascularization strategies is associated with lower risk for morbidity and mortality in this population. In the Arterial Revascularization Therapies Study (ARTS), we compared long-term clinical outcomes after CABG or PCI with multivessel stenting in patients with CKD.

METHODS

The ARTS randomly assigned 1205 participants with and without CKD to CABG or PCI with multivessel stenting. We defined CKD as creatinine clearance < or =60 mL/min, estimated by the Cockroft-Gault equation. The primary outcome was the composite of death, myocardial infarction (MI), or stroke; and, a secondary outcome was repeat revascularization. Participants were followed for a mean of 3 years after their intervention. We evaluated whether randomization to CABG or PCI was associated with different outcomes among participants with CKD.

RESULTS

Two hundred ninety participants (25%) had CKD at entry into ARTS. One hundred fifty-one received PCI, and 139 received CABG. No difference was observed in the primary endpoint with CABG or PCI among CKD participants (adjusted Hazard Ratio [HR] CABG vs PCI = 0.93; 95% CI 0.54-1.60; P = .97). However, CABG was associated with a reduced risk for repeat revascularization (HR = 0.28; 95% CI 0.14-0.54; P < .01). Compared with participants with normal renal function, CKD was associated with a nearly 2-fold risk for the primary outcome (unadjusted HR = 1.9; 95% CI 1.4-2.7; P < .01). After multivariate adjustment, this association remained significant (HR 1.6; 95% CI 1.1-2.4).

CONCLUSIONS

In patients with multivessel CAD and CKD, treatment with CABG or PCI with multivessel stenting led to similar outcomes of death, MI, or stroke, but CABG was associated with decreased repeat revascularizations. When compared with ARTS participants with normal renal function, those with CKD had substantially elevated risk of adverse clinical outcomes after coronary revascularization.

Authors+Show Affiliations

Department of Medicine, University of California, San Francisco, Calif, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

15864241

Citation

Ix, Joachim H., et al. "Association of Chronic Kidney Disease With Clinical Outcomes After Coronary Revascularization: the Arterial Revascularization Therapies Study (ARTS)." American Heart Journal, vol. 149, no. 3, 2005, pp. 512-9.
Ix JH, Mercado N, Shlipak MG, et al. Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS). Am Heart J. 2005;149(3):512-9.
Ix, J. H., Mercado, N., Shlipak, M. G., Lemos, P. A., Boersma, E., Lindeboom, W., O'Neill, W. W., Wijns, W., & Serruys, P. W. (2005). Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS). American Heart Journal, 149(3), 512-9.
Ix JH, et al. Association of Chronic Kidney Disease With Clinical Outcomes After Coronary Revascularization: the Arterial Revascularization Therapies Study (ARTS). Am Heart J. 2005;149(3):512-9. PubMed PMID: 15864241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS). AU - Ix,Joachim H, AU - Mercado,Nestor, AU - Shlipak,Michael G, AU - Lemos,Pedro A, AU - Boersma,Eric, AU - Lindeboom,Wietze, AU - O'Neill,William W, AU - Wijns,William, AU - Serruys,Patrick W, PY - 2005/5/3/pubmed PY - 2005/11/1/medline PY - 2005/5/3/entrez SP - 512 EP - 9 JF - American heart journal JO - Am. Heart J. VL - 149 IS - 3 N2 - BACKGROUND: Chronic kidney disease (CKD) is associated with adverse outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI), but it is unclear which of these revascularization strategies is associated with lower risk for morbidity and mortality in this population. In the Arterial Revascularization Therapies Study (ARTS), we compared long-term clinical outcomes after CABG or PCI with multivessel stenting in patients with CKD. METHODS: The ARTS randomly assigned 1205 participants with and without CKD to CABG or PCI with multivessel stenting. We defined CKD as creatinine clearance < or =60 mL/min, estimated by the Cockroft-Gault equation. The primary outcome was the composite of death, myocardial infarction (MI), or stroke; and, a secondary outcome was repeat revascularization. Participants were followed for a mean of 3 years after their intervention. We evaluated whether randomization to CABG or PCI was associated with different outcomes among participants with CKD. RESULTS: Two hundred ninety participants (25%) had CKD at entry into ARTS. One hundred fifty-one received PCI, and 139 received CABG. No difference was observed in the primary endpoint with CABG or PCI among CKD participants (adjusted Hazard Ratio [HR] CABG vs PCI = 0.93; 95% CI 0.54-1.60; P = .97). However, CABG was associated with a reduced risk for repeat revascularization (HR = 0.28; 95% CI 0.14-0.54; P < .01). Compared with participants with normal renal function, CKD was associated with a nearly 2-fold risk for the primary outcome (unadjusted HR = 1.9; 95% CI 1.4-2.7; P < .01). After multivariate adjustment, this association remained significant (HR 1.6; 95% CI 1.1-2.4). CONCLUSIONS: In patients with multivessel CAD and CKD, treatment with CABG or PCI with multivessel stenting led to similar outcomes of death, MI, or stroke, but CABG was associated with decreased repeat revascularizations. When compared with ARTS participants with normal renal function, those with CKD had substantially elevated risk of adverse clinical outcomes after coronary revascularization. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15864241/Association_of_chronic_kidney_disease_with_clinical_outcomes_after_coronary_revascularization:_the_Arterial_Revascularization_Therapies_Study__ARTS__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304007550 DB - PRIME DP - Unbound Medicine ER -