Abstract 1686: Percutaneous Coronary Intervention Improves Both Cardiac and All-cause Survival Compared with Medication Alone in Hemodialysis Patients with Single-vessel Disease - A Propensity Matched Analysis
Background: For low-risk single-vessel coronary artery disease (SVD), it has been reported that percutaneous coronary intervention (PCI) improves clinical symptoms but not survival in general population. However, it remains unclear in hemodialysis (HD) patients who are at high risk for coronary artery disease (CAD). We investigated whether PCI improves survival compared with medical therapy alone in HD patients with SVD.
Methods: Consecutive 352 HD patients with angiographical coronary stenosis were divided into two group treated with PCI (n=244) and medication alone (n=108). Of those, 129 patients with SVD were similarly divided into PCI group (n=80) and medication group (n=49). To minimize the selection bias for PCI or medication, a propensity-matched analysis using the model include male, age, diabetes, left ventricular ejection fraction and left anterior descending lesion was performed. The propensity score was matched 1:1 with two-digit (AUC=0.63 using ROC analysis). They were followed up for 5 years.
Results: Baseline characteristics were comparable between the PCI and medication group. During follow-up period (28±18months), 57 patients (16.2%) had cardiac death and 68 (19.3%) had non-cardiac death. On Kaplan-Meier analysis, cardiac and all-cause survival rates for 5 years were higher in PCI group than in medication group in all CAD patients (84% vs 64% and 60% vs 34%, both p<0.0001, respectively). In patients with SVD only, significant differences were also seen (91% vs. 76%, p=0.01 and 67% vs. 45%, p=0.005, respectively). After the propensity score matching in patients with SVD, still, cardiac and all-cause survival rate were higher in the PCI group than in medication group (93% vs. 64%, p = 0.001 and 75% vs. 46%, p = 0.007, respectively). On multivariate Cox analysis including traditional coronary risk factors, PCI was an independent predictor of better clinical outcomes in HD patients with SVD (cardiac mortality: hazard ratio 0.16, 95%CI 0.03– 0.89, p = 0.036, and all-cause mortality: hazard ratio 0.29, 95%CI 0.11– 0.81, p = 0.018, respectively).
Coclusion: These data suggest that PCI obviously improves both cardiac and all-cause survival compared with medication alone in HD Patients with SVD.