Abstract
Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD). However, the optimal strategy for coronary artery revascularization in advanced CKD patients who transition to ESRD is unclear.
Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, socio-demographics, comorbidities and medications.
Results: 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 79% were white, 19% were African Americans, and 84% were diabetics. The all-cause post-dialysis mortality rates after CABG and PCI were 229/1000 patient-years (PY) [95% CI: 205-256] and 311/1000PY [95% CI: 272-356], respectively. Compared to PCI, patients who underwent CABG had 34% lower risk of death [multivariable adjusted Hazard Ratio (95% CI) 0.66 (0.51-0.86), p=0.002] after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure and diabetes.
Conclusion: CABG in advanced CKD patients was associated lower risk of death after initiation of dialysis compared to PCI.
Original language | English |
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Pages (from-to) | 976-983.e7 |
Journal | Journal of Thoracic and Cardiovascular Surgery |
Volume | 157 |
Issue number | 3 |
DOIs | |
Publication status | Published - Mar 2019 |
Keywords
- Aged
- Coronary Artery Bypass/adverse effects
- Coronary Artery Disease/diagnosis
- Female
- Humans
- Incidence
- Kidney Failure, Chronic/diagnosis
- Male
- Middle Aged
- Percutaneous Coronary Intervention/adverse effects
- Renal Dialysis/adverse effects
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- United States/epidemiology
- Veterans