Predialysis coronary revascularization and postdialysis mortality

Abduzhappar Gaipov, Miklos Z Molnar, Praveen K Potukuchi, Keiichi Sumida, Robert B Canada, Oguz Akbilgic, Kairat Kabulbayev, Zoltan Szabo, Santhosh K G Koshy, Kamyar Kalantar-Zadeh, Csaba P Kovesdy

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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 languageEnglish
Pages (from-to)976-983.e7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number3
DOIs
Publication statusPublished - 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

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