Abstract 4684: Short- and Long-term Outcomes of Coronary Artery Bypass Graft Surgery or Drug-eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease: A Propensity Score Based Analysis
Background Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). However, no studies have yet compared short and long-term outcomes of coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for multivessel CAD among patients with CKD not needing hemodialysis(non HD CKD).
Methods In our institution’s registry, we identified 725 patients with non HD CKD (indicated by GFR of 15– 60 mL/min) who had either CABG or PCI for multivessel CAD between May 2003 and December 2006. Patients were followed up for median period of 822 days in PCI group and 828 days in CABG group. Short term (30 day) mortality, major adverse cardiovascular events (MACE), hemodialysis dependence after revascularization and long-term mortality were compared between these 2 groups. Outcomes (reported as hazard ratios [HRs]) were calculated by using the Cox proportional hazards model adjusted for baseline covariates and propensity score.
Results Short term MACE rates were higher in patients who underwent CABG (14.9%) than in patients who underwent PCI (7.5%; P=0.002). The PCI patients had more repeat revascularization at 30 days than the CABG patients (2.7% vs 0.4%; P=0.04). However, the method of revascularization was not a predictor of short-term mortality in multivariate regression analysis (odds ratio [OR], 2.1; 95% confidence interval [CI], 0.84 –5.3; P=0.1). After any form of revascularization, the incidence of hemodialysis dependence in the non HD CKD patients was 2.4%. When compared to PCI, CABG was associated with postoperative hemodialysis dependence (OR, 3.2; 95% [CI], 1.1–9.3; P<0.001). However, among the patients with non HD CKD and 3-vessel CAD, those who underwent CABG had a lower long-term mortality rate than those who underwent PCI (HR, 0.61; 95% CI, 0.36 –1.03; P=0.06). In non HD CKD patients who underwent revascularization for 2-vessel CAD, there was no difference in long-term mortality between CABG and PCI patients (HR, 1.12; 95% CI, 0.52–2.34; P=0.7).
Conclusions In patients with non HD CKD and multivessel CAD, CABG is associated with better survival than PCI with DES, but CABG patients have a greater short-term risk of needing permanent hemodialysis.