Published online before print September 30, 2002, doi: 10.1161/01.CIR.0000035248.71165.EB
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(Circulation. 2002;106:2207.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Comparative Survival of Dialysis Patients in the United States After Coronary Angioplasty, Coronary Artery Stenting, and Coronary Artery Bypass Surgery and Impact of Diabetes
From the Cardiovascular Special Studies Center (C.A.H., J.Z.M., A.J.C.), United States Renal Data System, Minneapolis, Minn; the Department of Preventive Medicine (J.Z.M.), University of Tennessee, Memphis; and the Department of Internal Medicine, Divisions of Cardiology (C.A.H.) and Nephrology (A.J.C.), Hennepin County Medical Center, University of Minnesota, Minneapolis.
Correspondence to Charles A. Herzog, MD, Department of Internal Medicine, Division of Cardiology, Hennepin County Medical Center, 701 Park Ave South, Minneapolis, MN 55415. E-mail cherzog{at}usrds.org
Background— The optimal method of coronary revascularization in dialysis patients is controversial. The purpose of this study was to compare the long-term survival of dialysis patients in the United States after PTCA, coronary stenting, or CABG.
Methods and Results— Dialysis patients hospitalized from 1995 to 1998 for first coronary revascularization procedures after renal replacement therapy initiation were identified from the US Renal Data System database. All-cause and cardiac survival was estimated by the life-table method and compared by the log-rank test. The impact of independent predictors on survival was examined in a Cox regression model. The in-hospital mortality was 8.6% for 6668 CABG patients, 6.4% for 4836 PTCA patients, and 4.1% for 4280 stent patients. The 2-year all-cause survival (mean±SEM) was 56.4±1.4% for CABG patients, 48.2±1.5% for PTCA patients, and 48.4±2.0% for stent patients (P<0.0001). After comorbidity adjustment, the relative risk (RR) for CABG (versus PTCA) patients was 0.80 (95% CI 0.76 to 0.84, P<0.0001) for all-cause death and 0.72 (95% CI 0.67 to 0.77, P<0.0001) for cardiac death. For stent (versus PTCA) patients, the RR was 0.94 (95% CI 0.88 to 0.99, P=0.03) for all-cause death and 0.92 (95% CI 0.85 to 0.99, P=0.04) for cardiac death. In diabetic (versus PTCA) patients, the RR for CABG surgery was 0.81 (95% CI 0.75 to 0.88, P<0.0001) for all-cause death and 0.71 (95% CI 0.64 to 0.78, P<0.0001) for cardiac death, and the RR for the stent procedure was 0.99 (95% CI 0.91 to 1.08, P=NS) for all-cause death and 0.99 (95% CI 0.89 to 1.11, P=NS) for cardiac death.
Conclusions— In this retrospective study, dialysis patients in the United States had better long-term survival after CABG surgery than after percutaneous coronary intervention. Stent outcomes were relatively worse in diabetic patients. Our data support the need for large clinical registries and prospective trials of surgical and percutaneous coronary revascularization procedures in dialysis patients.
Key Words: bypass • angioplasty • stents • kidney • survival
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