Advertisement

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

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Collins A.J.
        • Foley R.
        • Herzog C.
        • Chavers B.
        • Gilbertson D.
        • Ishani A.
        • Kasiske B.
        • Liu J.
        • Mau L.W.
        • McBean M.
        • Murray A.
        • St Peter W.
        • Xue J.
        • Fan Q.
        • Guo H.
        • Li Q.
        • Li S.
        • Li S.
        • Peng Y.
        • Qiu Y.
        • Roberts T.
        • Skeans M.
        • Snyder J.
        • Solid C.
        • Wang C.
        • Weinhandl E.
        • Zaun D.
        • Zhang R.
        • Arko C.
        • Chen S.C.
        • Dalleska F.
        • Daniels F.
        • Dunning S.
        • Ebben J.
        • Frazier E.
        • Hanzlik C.
        • Johnson R.
        • Sheets D.
        • Wang X.
        • Forrest B.
        • Constantini E.
        • Everson S.
        • Eggers P.
        • Agodoa L.
        Excerpts from the United States Renal Data System 2007 annual data report.
        Am J Kidney Dis. 2008; 51: S82-S83
        • Cooper W.A.
        • O'Brien S.M.
        • Thourani V.H.
        • Guyton R.A.
        • Bridges C.R.
        • Szczech L.A.
        • Petersen R.
        • Peterson E.D.
        Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database.
        Circulation. 2006; 113: 1063-1070
        • Le Feuvre C.
        • Dambrin G.
        • Helft G.
        • Tabet S.
        • Beygui F.
        • Legendre C.
        • Peraldi M.N.
        • Vacheron A.
        • Metzger J.P.
        Comparison of clinical outcome following coronary stenting or balloon angioplasty in dialysis versus non-dialysis patients.
        Am J Cardiol. 2000; 85: 1365-1368
        • Best P.J.
        • Lennon R.
        • Ting H.H.
        • Bell M.R.
        • Rihal C.S.
        • Holmes D.R.
        • Berger P.B.
        The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions.
        J Am Coll Cardiol. 2002; 39: 1113-1119
        • Herzog C.A.
        • Ma J.Z.
        • Collins A.J.
        Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes.
        Circulation. 2002; 106: 2207-2211
        • Szczech L.A.
        • Reddan D.N.
        • Owen W.F.
        • Califf R.
        • Racz M.
        • Jones R.H.
        • Hannan E.L.
        Differential survival after coronary revascularization procedures among patients with renal insufficiency.
        Kidney Int. 2001; 60: 292-299
        • Javaid A.
        • Steinberg D.H.
        • Buch A.N.
        • Corso P.J.
        • Boyce S.W.
        • Pinto Slottow T.L.
        • Roy P.K.
        • Hill P.
        • Okabe T.
        • Torguson R.
        • Smith K.A.
        • Xue Z.
        • Gevorkian N.
        • Suddath W.O.
        • Kent K.M.
        • Satler L.F.
        • Pichard A.D.
        • Waksman R.
        Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.
        Circulation. 2007; 116: I200-I206
        • Hannan E.L.
        • Wu C.
        • Walford G.
        • Culliford A.T.
        • Gold J.P.
        • Smith C.R.
        • Higgins R.S.
        • Carlson R.E.
        • Jones R.H.
        Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
        N Engl J Med. 2008; 358: 331-341
        • Halkin A.
        • Mehran R.
        • Casey C.W.
        • Gordon P.
        • Matthews R.
        • Wilson B.H.
        • Leon M.B.
        • Russell M.E.
        • Ellis S.G.
        • Stone G.W.
        Impact of moderate renal insufficiency on restenosis and adverse clinical events after paclitaxel-eluting and bare metal stent implantation: results from the TAXUS-IV Trial.
        Am Heart J. 2005; 150: 1163-1170
        • Halkin A.
        • Selzer F.
        • Marroquin O.
        • Laskey W.
        • Detre K.
        • Cohen H.
        Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients.
        J Invasive Cardiol. 2006; 18: 577-583
        • Madan P.
        • Elayda M.A.
        • Lee V.V.
        • Wilson J.M.
        Predicting major adverse cardiac events after percutaneous coronary intervention: the Texas Heart Institute risk score.
        Am Heart J. 2008; 155: 1068-1074
        • Herzog C.A.
        How to manage the renal patient with coronary heart disease: the agony and the ecstasy of opinion-based medicine.
        J Am Soc Nephrol. 2003; 14: 2556-2572
        • Aoki J.
        • Ong A.T.
        • Hoye A.
        • van Herwerden L.A.
        • Sousa J.E.
        • Jatene A.
        • Bonnier J.J.
        • Schonberger J.P.
        • Buller N.
        • Bonser R.
        • Lindeboom W.
        • Unger F.
        • Serruys P.W.
        Five year clinical effect of coronary stenting and coronary artery bypass grafting in renal insufficient patients with multivessel coronary artery disease: insights from ARTS trial.
        Eur Heart J. 2005; 26: 1488-1493
        • Stallwood M.I.
        • Grayson A.D.
        • Mills K.
        • Scawn N.D.
        Acute renal failure in coronary artery bypass surgery: independent effect of cardiopulmonary bypass.
        Ann Thorac Surg. 2004; 77: 968-972