Abstract 13346: Impact of Renal Function in Patients With Multi-Vessel Coronary Disease (MVD) on Long Term Mortality Following Coronary Artery Bypass Grafting (CABG) Compared With Percutaneous Coronary Intervention (PCI)
Background: Renal failure is an important predictor of mortality in patients with MVD who undergo coronary revascularization. We sought to determine if the degree of renal impairment affects long-term mortality based on choice of revascularization strategy.
Method: We analysed 7,841 patients with MVD undergoing either CABG (n=6,739) or PCI (n=1,102) between 2004-2008, enrolled in two large multi-centre Australian registries. Patients were assigned to three groups using stratified propensity matching based on their estimated glomerular filtration rate (eGFR) at baseline; ≥60 (CABG=4,674 vs. PCI=839), 30-59 (CABG=1,799 vs. PCI=226) and <30ml/min/1.73m2 (CABG=266 vs. PCI=37) respectively. Shock, myocardial infarction (MI) <24 hours, previous CABG, valve surgery or PCI were exclusions. We compared Cox-proportional hazards-adjusted National Death Index-linked long-term mortality (mean 3.2 years).
Results: In patients with eGFR30-59 and ≥60mL/min/1.73cm2, there were more women, octogenarians and recent MI in the PCI group and a higher prevalence of cerebrovascular disease, peripheral vascular disease, prior heart failure and MI in the CABG group. Observed long-term mortality rates (CABG vs. PCI) were 4.8% vs. 4.3% p=0.50, 11.3% vs. 17.3% p=0.009, 19.9% vs. 40.5% p=0.005 in the three strata, respectively. Following adjustment, patients with eGFR≥60ml/min/1.73cm2 had no significant difference in long-term mortality. However, with eGFR30-59mL/min/1.73cm2, PCI was an independent predictor of long-term mortality (HR1.55, 95%CI1.07-2.25, p=0.02). For eGFR<30mL/min/1.73cm2, there was a trend towards higher mortality with PCI (HR1.80, 95%CI0.95-3.41, p=0.07).
Conclusion: In this stratified, propensity-matched study there was a long-term mortality hazard associated with PCI for patients with eGFR30-59ml/min/1.73m². The effect may be higher for eGFR<30ml/min/1.73m²
- © 2011 by American Heart Association, Inc.