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.
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Article info
Publication history
Published online: June 21, 2010
Accepted:
March 9,
2010
Received in revised form:
March 9,
2010
Received:
December 21,
2009
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
