Korean Circ J.  2017 May;47(3):354-360. 10.4070/kcj.2016.0439.

Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

• Kang SH
• Lee CW
• Yun SC
• Lee PH
• Ahn JM
• Park DW
• Kang SJ
• Lee SW
• Kim YH
• Park SW
• Park SJ

• KMID: 2385389
• DOI: http://doi.org/10.4070/kcj.2016.0439

Abstract

BACKGROUND AND OBJECTIVES
There is currently a limited amount of data that demonstrate the optimal revascularization strategy for chronic kidney disease (CKD) patients with multivessel coronary artery disease (CAD). We compared the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for multivessel CAD in patients with CKD.
SUBJECTS AND METHODS
We analyzed 2108 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m²) with multivessel CAD that were treated with PCI with DES (n=1165) or CABG (n=943). The primary outcome was a composite of all causes of mortality, myocardial infarction, or stroke. The mean age was 66.9±9.1 years.
RESULTS
Median follow-up duration was 41.4 (interquartile range 12.1-75.5) months. The primary outcome occurred in 307 (26.4%) patients in the PCI group compared with 304 (32.2%) patients in the CABG group (adjusted hazard ratio [HR], 0.941; 95% confidence interval [CI], 0.79-1.12; p=0.493). The two groups exhibited similar rates of all-cause mortality (adjusted HR, 0.91; 95% CI, 0.77-1.09; p=0.295), myocardial infarction (adjusted HR, 1.86; 95% CI, 0.85-4.07; p=0.120) and stroke (3.2% vs. 4.8%; HR, 0.93; 95% CI, 0.57-1.61; p=0.758). However, PCI was associated with significantly increased rates of repeat revascularization (adjusted HR, 4.72; 95% CI, 3.20-6.96; p<0.001).
CONCLUSION
Among patients with CKD and multivessel CAD, PCI with DES when compared with CABG resulted in similar rates of composite outcome of mortality from any cause, MI, or stroke; however, a higher risk of repeat revascularization was observed.

Keyword

Coronary artery bypass; Coronary disease; Percutaneous coronary intervention; Renal insufficiency

MeSH Terms

Coronary Artery Bypass*
Coronary Artery Disease
Coronary Disease
Coronary Vessels*
Drug-Eluting Stents
Follow-Up Studies
Glomerular Filtration Rate
Humans
Mortality
Myocardial Infarction
Percutaneous Coronary Intervention
Renal Insufficiency
Renal Insufficiency, Chronic*
Stroke
Transplants

Figure

• 

  Fig. 1 Kaplan-Meier curves of cumulative incidence of (A) mortality, myocardial infarction, or stroke, (B) mortality, (C) myocardial infarction, and (D) stroke in patients treated with percutaneous coronary intervention (solid line) versus coronary artery bypass graft (dashed line). PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft.

• 

  Fig. 2 Kaplan-Meier curves of cumulative incidence of mortality, myocardial infarction, or stroke in patients with (A) renal replacement therapy, (B) three-vessel disease, (C) diabetes mellitus, or (D) left ventricular ejection fraction <40, treated with percutaneous coronary intervention (solid line) versus coronary artery bypass graft (dashed line). PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft.

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