Abstract 9817: The Changing Practice of Coronary Revascularization of Dialysis Patients in the US, 2004-2009
INTRODUCTION: The optimal method of coronary artery revascularization in dialysis pts is controversial. In-stent restenosis complicates the use of bare metal stents (BMS), prolonged dual anti-platelet therapy (and attendant hemorrhagic risk, including in transplant waitlisted pts) is problematic for drug-eluting stents (DES), and coronary artery bypass surgery (CAB) has markedly increased in-hospital mortality, but superior long-term survival. There are few published data comparing recent trends in selection of coronary revascularization procedures in dialysis pts.
METHODS: We searched the records of the United States Renal Data System database to identify 23,038 dialysis pts having coronary artery bypass surgery (CAB), BMS or DES in 2004-2009. One year survival was estimated by Kaplan-Meier method.
RESULTS: During the study period, the total number of revascularization procedures decreased from 4,347 in 2004 to 3,344 in 2009. CAB procedures typically accounted for 25% to 30% of all procedures. From 2004-2006, DES accounted for 59% of procedures and BMS 15%. However, from 2007-2009 those percentages were 43% and 31%, respectively. From 2006 to 2007 alone, the number of DES pts dropped from 2,495 to 1,462 (a 41% reduction) while the number of BMS pts increased from 607 to 1,121 (an 85% increase). Survival for CAB and DES pts, but not BMS improved for 2009 vs 2004 pts (p= .002, p= .015, p= ns, respectively by log rank test).
CONCLUSION: Our data suggest a recent shift in interventional practice patterns in US dialysis pts, with a reduction in the use of DES. Despite prior reports of superior long-term survival after CAB, only 25% of coronary revascularization was CAB in 2009. Unadjusted survival after DES and CAB improved from 2004 to 2009.
- © 2012 by American Heart Association, Inc.