Abstract 4342: Long-Term Survival and Repeat Revascularization in US Dialysis Patients After Surgical versus Percutaneous Coronary Intervention
Introduction: There are few published data on the comparative survival and risk of subsequent repeat coronary revascularization of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents (DES).
Methods: We searched the records of the United States Renal Data System database to identify 4,352 dialysis pts having coronary artery bypass surgery,(CAB), bare metal stents (BMS), or DES in 2004. Long-term event-free survival for all-cause mortality, repeat revascularization (CAB or PCI), and the combined event of death or repeat revascularization was estimated by Kaplan-Meier method and independent predictors of death, repeat revascularization, and the combined event of death or repeat revascularization were examined in a comorbidity-adjusted Cox model.
Results: There were 1371 CAB pts, 2224 DES pts, and 757 BMS pts. The Tables⇓ show survival and predictors of the endpoints of death, repeat revascularization, and the combined event of death or repeat revascularization (age <65, male, white, hemodialysis, time on dialysis <2 years, no comorbidity, CAB is reference) with hazard ratio (HR). DES patients have the best survival at 12 months, but CAB patients have the best long-term survival. The risk of repeat coronary revascularization is lowest in CAB patients, while DES and BMS patients have similar rates of repeat revascularization.
Conclusion: Our data suggest that DES provide the best first year survival in dialysis pts, but CAB patients have better un-adjusted long-term survival and lower risk of repeat coronary revascularization.