Abstract 10977: Survival After Surgical or Percutaneous Revascularization in US Dialysis Patients Without Acute Myocardial Infarction
Background: Previously published data in US dialysis pts demonstrate that CABG has a higher initial mortality hazard but better long-term survival relative to PCI. However, previous studies failed to differentiate pts with acute myocardial infarction (AMI) in the analyses. We sought to evaluate the survival of dialysis pts without AMI undergoing coronary revascularization.
Methods: Using the United States Renal Data System database, we identified 23,033 dialysis pts undergoing revascularization, 2004-2009 (6178 CABG; 11,844 DES, 5011 BMS). Pts with AMI (based on ICD-9 codes) were excluded from this cohort to identify pts undergoing revascularization in the non-AMI cohort (n=14,775, 64%). Long-term survival was estimated by Kaplan-Meier method and independent predictors of death examined in a comorbidity-adjusted Cox model.
Results: Proportion of pts undergoing revascularization in non-AMI setting were 4358 (29.5%) CABG; 7634 (51.7%) DES; 2783 (18.8%) BMS. There was a significant initial mortality hazard with CABG vs. PCI with DES (1 month survival 90% vs. 97%), but 2 yr survival was similar (61% vs. 60%) (Table 1). No significant difference was noted in long-term survival between CABG vs. PCI with DES (HR 1.01; p=0.85 at 6 yrs) (Table 2). PCI with BMS was an independent predictor of long-term mortality (HR 1.14, p<.0001), similar to the overall cohort. Other independent predictors of mortality (Table 2) were age>65 yrs, white race, congestive heart failure, diabetes, peritoneal dialysis.
Conclusions: Although CABG was associated with improved long-term survival relative to DES in all dialysis pts undergoing revascularization; among pts without AMI, there was no statistically significant long-term survival difference between CABG and DES. PCI with BMS was associated with significantly increased long-term mortality relative to CABG among pts without AMI.
- © 2013 by American Heart Association, Inc.