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Coronary artery bypass surgery is superior to percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis.
Ann Thorac Surg. 2010 Jun; 89(6):1896-900; discussion 1900.AT

Abstract

BACKGROUND

Improvements in the results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with all forms of coronary artery disease. The purpose of this study was to compare the midterm clinical results of coronary artery bypass surgery (CABG) and PCI with DES in patients with chronic renal failure on hemodialysis.

METHODS

From January 2002 to December 2006, 29 patients underwent CABG, and 75 patients underwent PCI with DES. For CABG, 24 patients had off-pump surgery. The mean follow-up was 32.0 +/- 22.0 months for CABG and 23.5 +/- 14.8 months for PCI. Survival, cardiac death, major adverse cardiac events (cardiac death, myocardial infarction, revascularization), and target lesion revascularization were analyzed using the Kaplan-Meier method.

RESULTS

Preoperative characteristics and risk factors were compatible between the groups except for the European System for Cardiac Operative Risk Evaluation (7.3 +/- 2.7 for CABG and 5.0 +/- 2.4 for PCI, p < 0.0001) and the presence of a left main trunk lesion (53.3% for CABG and 18.7% for PCI). Thirty-day mortality was 3.3% for CABG and 4.0% for PCI. The 2-year survival rate was 84.0% for CABG and 67.6% for PCI (p = 0.0271). The cardiac death-free curve at 2 years was 100% for CABG and 84.1% for PCI (p = 0.0122). The major adverse cardiac events-free rate at 2 years was 75.8% for CABG and 31.5% for PCI (p < 0.0001). During the follow-up period, there were 6 late deaths in the CABG group and 27 late deaths (including 6 sudden deaths) in the PCI group.

CONCLUSIONS

Coronary artery bypass grafting was superior to PCI with DES in patients with chronic renal failure on hemodialysis in terms of long-term outcomes for cardiac death, major adverse cardiac events, and target lesion revascularization. The DES carried a higher risk for sudden death, which might be associated with stent thrombosis.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan. gengo.sunagawa@hotmail.co.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20494045

Citation

Sunagawa, Gengo, et al. "Coronary Artery Bypass Surgery Is Superior to Percutaneous Coronary Intervention With Drug-eluting Stents for Patients With Chronic Renal Failure On Hemodialysis." The Annals of Thoracic Surgery, vol. 89, no. 6, 2010, pp. 1896-900; discussion 1900.
Sunagawa G, Komiya T, Tamura N, et al. Coronary artery bypass surgery is superior to percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis. Ann Thorac Surg. 2010;89(6):1896-900; discussion 1900.
Sunagawa, G., Komiya, T., Tamura, N., Sakaguchi, G., Kobayashi, T., & Murashita, T. (2010). Coronary artery bypass surgery is superior to percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis. The Annals of Thoracic Surgery, 89(6), 1896-900; discussion 1900. https://doi.org/10.1016/j.athoracsur.2010.02.080
Sunagawa G, et al. Coronary Artery Bypass Surgery Is Superior to Percutaneous Coronary Intervention With Drug-eluting Stents for Patients With Chronic Renal Failure On Hemodialysis. Ann Thorac Surg. 2010;89(6):1896-900; discussion 1900. PubMed PMID: 20494045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary artery bypass surgery is superior to percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis. AU - Sunagawa,Gengo, AU - Komiya,Tatsuhiko, AU - Tamura,Nobushige, AU - Sakaguchi,Genichi, AU - Kobayashi,Taira, AU - Murashita,Takashi, PY - 2009/04/29/received PY - 2010/02/24/revised PY - 2010/02/26/accepted PY - 2010/5/25/entrez PY - 2010/5/25/pubmed PY - 2010/6/17/medline SP - 1896-900; discussion 1900 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 89 IS - 6 N2 - BACKGROUND: Improvements in the results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with all forms of coronary artery disease. The purpose of this study was to compare the midterm clinical results of coronary artery bypass surgery (CABG) and PCI with DES in patients with chronic renal failure on hemodialysis. METHODS: From January 2002 to December 2006, 29 patients underwent CABG, and 75 patients underwent PCI with DES. For CABG, 24 patients had off-pump surgery. The mean follow-up was 32.0 +/- 22.0 months for CABG and 23.5 +/- 14.8 months for PCI. Survival, cardiac death, major adverse cardiac events (cardiac death, myocardial infarction, revascularization), and target lesion revascularization were analyzed using the Kaplan-Meier method. RESULTS: Preoperative characteristics and risk factors were compatible between the groups except for the European System for Cardiac Operative Risk Evaluation (7.3 +/- 2.7 for CABG and 5.0 +/- 2.4 for PCI, p < 0.0001) and the presence of a left main trunk lesion (53.3% for CABG and 18.7% for PCI). Thirty-day mortality was 3.3% for CABG and 4.0% for PCI. The 2-year survival rate was 84.0% for CABG and 67.6% for PCI (p = 0.0271). The cardiac death-free curve at 2 years was 100% for CABG and 84.1% for PCI (p = 0.0122). The major adverse cardiac events-free rate at 2 years was 75.8% for CABG and 31.5% for PCI (p < 0.0001). During the follow-up period, there were 6 late deaths in the CABG group and 27 late deaths (including 6 sudden deaths) in the PCI group. CONCLUSIONS: Coronary artery bypass grafting was superior to PCI with DES in patients with chronic renal failure on hemodialysis in terms of long-term outcomes for cardiac death, major adverse cardiac events, and target lesion revascularization. The DES carried a higher risk for sudden death, which might be associated with stent thrombosis. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/20494045/Coronary_artery_bypass_surgery_is_superior_to_percutaneous_coronary_intervention_with_drug_eluting_stents_for_patients_with_chronic_renal_failure_on_hemodialysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(10)00493-5 DB - PRIME DP - Unbound Medicine ER -