Abstract 12514: Percutaneous Coronary Intervention is Beneficial For Better Survival Compared With Medication Alone in Chronic Hemodialysis Patients With Single-Vessel Disease

Abstract

Background: Percutaneous coronary intervention (PCI) has been widely performed for coronary artery disease (CAD) even in hemodialysis (HD) patients. For single-vessel disease (SVD), PCI has been reported to improve clinical symptoms but not survival in general population, however, it remains unclear in HD patients who are regard as the highest risk group of cardiac mortality. We investigated whether PCI improves survival compared to medical therapy alone in HD patients.

Methods: Of 391 consecutive HD patients with angiographical single coronary artery stenosis, 279 patients were treated with PCI (PCI group) and 112 patients were treated with medication alone (medication group). To minimize the selection bias for PCI or medication, a propensity-matched analysis using multiple logistic regression model include male, age, diabetes, ejection fraction, left anterior descending lesion and history of cardiovascular disease was performed. Each patients in the medication group were matched with up to two patients in the PCI group PCI with two-digit propensity score (AUC = 0.63 using ROC analysis). They were followed up for up to 8 years.

Results: Baseline characteristics were comparable between both groups. During follow-up period (mean 44±32 months), 82 patients died (22 cardiac) in the PCI group and 54 patients died (22 cardiac) in the medication group. Eight-year Kaplan-Meier survival rate for cardiac and all-cause mortality were significantly higher in the PCI group than in the medication group (87.3% vs. 71.2% and 52.4% vs. 31.0%, both p < 0.0001). After the propensity score matching, 187 patients treated with PCI and 109 patients treated with medication alone were matched. Still, cardiac and all-cause survival rate were higher in the PCI group than in the medication group (83.3% vs. 70.6%, p = 0.0004 and 47.8% vs. 31.3%, p = 0.0008). On multivariate Cox analysis, PCI was an independent predictor of better survival for cardiac mortality [HR 0.35, 95% confidential interval (CI) 0.19-0.67, p = 0.0019] and all-cause mortality (HR 0.54, 95%CI 0.33-0.87, p = 0.012).

Conclusion: These data suggest that PCI has more beneficial effect on clinical outcome including both cardiac and all-cause survival compared to medication alone in HD patients even with SVD.