Abstract 16395: Comparative Long-Term Risk of Death and Graft Failure in Renal Transplant Recipients 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 graft failure after coronary artery bypass surgery (CAB) vs percutaneous coronary intervention (PCI) in pts with renal transplants. Using the USRDS database, we identified 4534 pts with functioning renal transplants having CAB (n= 1003) and PCI (n= 3531) in 2001-2007. Event-free survival for death, non-fatal graft failure and the combined event of graft failure or death was estimated by Kaplan-Meier method and independent predictors of death or graft failure were examined in a comorbidity-adjusted Cox model.
Results: The CAB pts were 69% male, 83% white, 35% age 65+, 76% 3+ arteries bypassed, 17% were “Off-Pump,” PCI pts were 66% male, 81% white, 37% age 65+. 84% 1-vessel PCI, 36% bare metal stent (BMS), 36% drug-eluting stent (DES), 27% percutaneous transluminal coronary angioplasty (PTCA). In-hospital death was 5.3% for CAB and 2.3% for PCI. Risk of non-fatal graft failure for Off-Pump CAB (vs on-Pump CAB) was not significant: HR (0.78(0.47,1.30)). The Table shows estimated event-free survival and predictors of death and graft failure.
Conclusion: Unadjusted survival and freedom from non-fatal graft failure is marginally better in renal transplant pts after PCI compared to CAB, but after adjustment for baseline demographic characteristics and comorbid medical conditions, there is no difference in outcome for PCI vs CAB. Race is independently associated with the risk of graft failure after coronary revascularization in renal transplant pts.
- © 2011 by American Heart Association, Inc.