Abstract 16231: Comparative Long-Term Risk of Death and End-Stage Renal Disease (ESRD) in Medicare Patients With Chronic Kidney Disease Undergoing Coronary Revascularization With Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention
Introduction/Methods: There are few published data on the comparative long-term risk of developing End-Stage Renal Disease (ESRD) after coronary artery bypass surgery (CAB) vs percutaneous coronary intervention (PCI) in pts with chronic kidney disease (CKD). Using the Medicare 5% Database, we identified 4547 CKD pts having CAB and 8620 with PCI (age 66+ yrs, ESRD excluded) in 2001-2007. Event-free survival for death, ESRD and the combined event of ESRD or death was estimated by Kaplan-Meier method and independent predictors of death or ESRD were examined in a comorbidity-adjusted Cox model.
Results: The CAB pts were 67% male, 89% white, 53% age 75+, 82% 3+ arteries bypassed, 16% were “Off-Pump,” PCI pts were 56% male, 87% white, 60% age 75+. 77% 1-vessel PCI, 48% bare metal stent (BMS), 42% drug-eluting stent (DES), 10% percutaneous transluminal coronary angioplasty (PTCA). In-hospital death was 7.1% for CAB and 3.9% for PCI. Risk of ESRD for Off-Pump CAB (vs on-Pump CAB) was not significant: HR (0.96 (0.68,1.35)). The Table shows estimated event-free survival and predictors of death and ESRD.
Conclusion: Unadjusted short-term ( <= 1 yr) survival is better in CKD pts after PCI, but long-term survival of CKD pts is better following CAB. The risk of death markedly exceeds the development of ESRD after coronary revascularization in elderly CKD pts. The risk of developing ESRD in elderly CKD pts is higher after CAB vs. PCI.
- © 2011 by American Heart Association, Inc.