Published Online
on September 27, 2004

A more recent version of this article appeared on October 5, 2004

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Submitted on May 27, 2004
Revised on July 21, 2004
Accepted on August 2, 2004

Survival After Coronary Revascularization Among Patients With Kidney Disease

Brenda R. Hemmelgarn PhD, MD^*, Danielle Southern MSc, Bruce F. Culleton MD, L. Brent Mitchell MD, Merril L. Knudtson MD, William A. Ghali MD, MPH, for the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Investigators

From the Departments of Medicine (B.R.H., B.F.C., L.B.M., M.L.K., W.A.G.) and Community Health Sciences (B.R.H., W.A.G.) and the Centre for Health and Policy Studies (D.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada.

^* To whom correspondence should be addressed. E-mail: brenda.hemmelgarn{at}calgaryhealthregion.ca.

Background--The optimal approach to revascularization in patients with kidney disease has not been determined. We studied survival by treatment group (CABG, percutaneous coronary intervention [PCI], or no revascularization) for patients with 3 categories of kidney function: dialysis-dependent kidney disease, non-dialysis-dependent kidney disease, and a reference group (serum creatinine <2.3 mg/dL).

Methods and Results--Data were derived from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), which captures information on all patients undergoing cardiac catheterization in Alberta, Canada. Characteristics and patient survival in 662 dialysis patients (1.6%) and 750 non-dialysis-dependent kidney disease patients (1.8%) were compared with the remainder of the 40 374 patients (96.6%). For the reference group, the adjusted 8-year survival rates for CABG, PCI, and no revascularization (NR) were 85.5%, 80.4%, and 72.3%, respectively (P<0.001 for CABG versus NR; P<0.001 for PCI versus NR). Adjusted survival rates were 45.9% for CABG, 32.7% for PCI, and 29.7% for NR in the nondialysis kidney disease group (P<0.001 for CABG versus NR; P=0.48 for PCI versus NR) and 44.8% for CABG, 41.2% for PCI, and 30.4% for NR in the dialysis group (P=0.003 for CABG versus NR; P=0.03 for PCI versus NR).

Conclusions--Compared with no revascularization, CABG was associated with better survival in all categories of kidney function. PCI was also associated with a lower risk of death than no revascularization in reference patients and dialysis-dependent kidney disease patients but not in patients with non-dialysis-dependent kidney disease. The presence of kidney disease or dependence on dialysis should not be a deterrent to revascularization, particularly with CABG.

Key words: revascularization • coronary disease • kidney • epidemiology

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Circulation 2004 110: 1875. [Extract] [Full Text]

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