Korean J Intern Med.  2007 Sep;22(3):139-146. 10.3904/kjim.2007.22.3.139.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

• Bae KS
• Park HC
• Kang BS
• Park JW
• Chon NR
• Oh KJ
• Yoon YW
• Hong YS
• Ha SK

• KMID: 1785618
• DOI: http://doi.org/10.3904/kjim.2007.22.3.139

Abstract

BACKGROUND: Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. METHODS: The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. RESULTS: The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1 % vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). CONCLUSIONS: The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.

Keyword

Diabetic Nephropathy; Coronary Artery Disease; Coronary Artery Bypass Grafting; Percutaneous Transluminal Coronary Angioplasty

MeSH Terms

Aged
*Angioplasty, Transluminal, Percutaneous Coronary/adverse effects
*Coronary Artery Bypass/adverse effects
Coronary Artery Disease/complications/surgery/*therapy
*Diabetic Nephropathies/complications
Female
Humans
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Survival Analysis
Treatment Outcome