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Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease.
Am J Cardiol. 2010 Aug 01; 106(3):348-53.AJ

Abstract

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent. The rates of 30-day and long-term mortality, 30-day major adverse cardiovascular events, and hemodialysis dependence after revascularization were compared between these 2 groups by computing the hazard ratios from a Cox proportional hazards model and adjusting them for the baseline covariates and propensity score. After either CABG or PCI, 2.4% of the patients with non-HD CKD were hemodialysis dependent. Compared to PCI, CABG was associated with postoperative hemodialysis dependence (odds ratio 3.2, 95% confidence interval 1.1 to 9.3; p <0.001). However, among patients with non-HD CKD and 3-vessel CAD, those who underwent CABG tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61, 95% confidence interval 0.36 to 1.03; p = 0.06). In the patients with non-HD CKD treated for 2-vessel CAD, those who underwent CABG or PCI had a similar long-term mortality risk (hazard ratio 1.12, 95% confidence interval 0.52 to 2.34; p = 0.7). In conclusion, in patients with non-HD CKD and multivessel CAD, CABG led to better survival than PCI with drug-eluting stents, but CABG patients had a greater short-term risk of requiring permanent hemodialysis.

Authors+Show Affiliations

Division of Cardiology, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20643244

Citation

Ashrith, Guha, et al. "Short- and Long-term Outcomes of Coronary Artery Bypass Grafting or Drug-eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease." The American Journal of Cardiology, vol. 106, no. 3, 2010, pp. 348-53.
Ashrith G, Lee VV, Elayda MA, et al. Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease. Am J Cardiol. 2010;106(3):348-53.
Ashrith, G., Lee, V. V., Elayda, M. A., Reul, R. M., & Wilson, J. M. (2010). Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease. The American Journal of Cardiology, 106(3), 348-53. https://doi.org/10.1016/j.amjcard.2010.03.037
Ashrith G, et al. Short- and Long-term Outcomes of Coronary Artery Bypass Grafting or Drug-eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease. Am J Cardiol. 2010 Aug 1;106(3):348-53. PubMed PMID: 20643244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease. AU - Ashrith,Guha, AU - Lee,Vei-Vei, AU - Elayda,Macarthur A, AU - Reul,Ross M, AU - Wilson,James M, Y1 - 2010/06/18/ PY - 2009/12/21/received PY - 2010/03/09/revised PY - 2010/03/09/accepted PY - 2010/7/21/entrez PY - 2010/7/21/pubmed PY - 2010/8/13/medline SP - 348 EP - 53 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 106 IS - 3 N2 - Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent. The rates of 30-day and long-term mortality, 30-day major adverse cardiovascular events, and hemodialysis dependence after revascularization were compared between these 2 groups by computing the hazard ratios from a Cox proportional hazards model and adjusting them for the baseline covariates and propensity score. After either CABG or PCI, 2.4% of the patients with non-HD CKD were hemodialysis dependent. Compared to PCI, CABG was associated with postoperative hemodialysis dependence (odds ratio 3.2, 95% confidence interval 1.1 to 9.3; p <0.001). However, among patients with non-HD CKD and 3-vessel CAD, those who underwent CABG tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61, 95% confidence interval 0.36 to 1.03; p = 0.06). In the patients with non-HD CKD treated for 2-vessel CAD, those who underwent CABG or PCI had a similar long-term mortality risk (hazard ratio 1.12, 95% confidence interval 0.52 to 2.34; p = 0.7). In conclusion, in patients with non-HD CKD and multivessel CAD, CABG led to better survival than PCI with drug-eluting stents, but CABG patients had a greater short-term risk of requiring permanent hemodialysis. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/20643244/Short__and_long_term_outcomes_of_coronary_artery_bypass_grafting_or_drug_eluting_stent_implantation_for_multivessel_coronary_artery_disease_in_patients_with_chronic_kidney_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(10)00786-1 DB - PRIME DP - Unbound Medicine ER -