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.
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Article info
Publication history
Published online: June 05, 2014
Accepted:
May 13,
2014
Received in revised form:
May 13,
2014
Received:
February 20,
2014
Footnotes
This work was supported by the Pharmaceuticals and Medical Devices Agency (PMDA) in Tokyo, Japan.
See page 560 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
