Abstract 2539: Comparative Long-Term Survival of General Medicare Patients with Surgical versus Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents and Impact of Chronic Kidney Disease
Few data exist on the comparative survival of elderly pts with chronic kidney disease (CKD) undergoing surgical vs. percutaneous coronary revascularization in the era of drug eluting stents (DES). We searched the claims records of 3,679,761 pts in the 5% General Medicare database to find pts having coronary artery bypass surgery (CAB) or percutaneous coronary intervention (PCI) with DES or non-DES (non drug eluting stent) in 2004. Patients with End Stage Renal Disease were excluded. Long-term survival was estimated by Kaplan-Meier method and independent predictors of death were examined in a comorbidity-adjusted Cox model. There were 5,140 CAB pts (16% CKD), 2,826 non-DES pts (12% CKD), and 9,896 DES pts (10% CKD). The cohort was 59.8% male, 91.3% white, 47.2% age 65–74, 44.8% age 75– 84, and 8.1% age 85+. 2,130 pts (11.9%) had CKD and 35.4% had diabetes. The Table⇓ shows survival and predictors of death in CKD pts (age 65–74, male, white, no comorbidity, CAB is reference) with risk ratio (RR). Increased mortality occurs in elderly CKD undergoing coronary revascularizaton. Our data suggest that the two year survival of General Medicare patients with CKD is better with DES compared to CAB.