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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).
Am J Cardiol. 2014 Aug 15; 114(4):555-61.AJ

Abstract

Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p <0.001) and left main disease (10% vs 34%, p <0.001). Preprocedural Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score in the CABG group was significantly higher than that in the PCI group (23.5 ± 8.7 vs 29.4 ± 11.0, p <0.001). Unadjusted 30-day mortality was 2.7% for PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (HR 2.10, 95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83, 95% CI 1.01 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p <0.001). Among the 201 patients who died during the follow-up, 94 patients (47%) died from noncardiac morbidities such as stroke, respiratory failure, and renal failure. In patients with multivessel and/or left main disease undergoing dialysis, 5-year outcomes revealed that CABG relative to PCI reduced the risk of cardiac death, sudden death, myocardial infarction, and any revascularization. However, the risk of all-cause death was not different between PCI and CABG.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: marui@kuhp.kyoto-u.ac.jp.Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan.Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24996550

Citation

Marui, Akira, et al. "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, vol. 114, no. 4, 2014, pp. 555-61.
Marui A, Kimura T, Nishiwaki N, et al. 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). Am J Cardiol. 2014;114(4):555-61.
Marui, A., Kimura, T., Nishiwaki, N., Mitsudo, K., Komiya, T., Hanyu, M., Shiomi, H., Tanaka, S., & Sakata, R. (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, 114(4), 555-61. https://doi.org/10.1016/j.amjcard.2014.05.034
Marui A, et al. 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). Am J Cardiol. 2014 Aug 15;114(4):555-61. PubMed PMID: 24996550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Marui,Akira, AU - Kimura,Takeshi, AU - Nishiwaki,Noboru, AU - Mitsudo,Kazuaki, AU - Komiya,Tatsuhiko, AU - Hanyu,Michiya, AU - Shiomi,Hiroki, AU - Tanaka,Shiro, AU - Sakata,Ryuzo, AU - ,, Y1 - 2014/06/06/ PY - 2014/02/20/received PY - 2014/05/13/revised PY - 2014/05/13/accepted PY - 2014/7/6/entrez PY - 2014/7/6/pubmed PY - 2015/2/12/medline SP - 555 EP - 61 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 114 IS - 4 N2 - Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p <0.001) and left main disease (10% vs 34%, p <0.001). Preprocedural Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score in the CABG group was significantly higher than that in the PCI group (23.5 ± 8.7 vs 29.4 ± 11.0, p <0.001). Unadjusted 30-day mortality was 2.7% for PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (HR 2.10, 95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83, 95% CI 1.01 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p <0.001). Among the 201 patients who died during the follow-up, 94 patients (47%) died from noncardiac morbidities such as stroke, respiratory failure, and renal failure. In patients with multivessel and/or left main disease undergoing dialysis, 5-year outcomes revealed that CABG relative to PCI reduced the risk of cardiac death, sudden death, myocardial infarction, and any revascularization. However, the risk of all-cause death was not different between PCI and CABG. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/24996550/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__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(14)01227-2 DB - PRIME DP - Unbound Medicine ER -