Abstract 14567: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis: 5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2
Background: Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease (ESRD). However, long-term benefit of percutaneous coronary intervention (PCI) with drug-eluting stent (DES) or coronary artery bypass grafting (CABG) in those patients still has been unclear.
Methods and Results: We identified 388 patients with multivessel and/or left main disease with ESRD requiring dialysis of 15,939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. There were 258 patients undergoing PCI (DES: 74%) and 130 CABG. The CABG group included more patients with triple-vessel (40% vs. 68%, p<0.01) and left main disease (9.7% vs. 34%, p<0.01). Preprocedural SYNTAX Score of the CABG group was significantly higher than PCI (23.5 ± 8.7 vs. 29.4 ± 11.0, p<0.01). Thirty-day mortality was not different between PCI and CABG (0.4% vs. 0%, p=0.47). Five-year outcomes revealed that the risk of target lesion revascularization after PCI was much higher than CABG (hazard ratio [95% confidence interval]; 5.03 [2.52-10.0], p<0.01). In addition, the risk of myocardial infarction after PCI tended to be higher than CABG (2.06 [0.98-4.33], p=0.057). However, the risk of all-cause death and cardiac death were not different between PCI and CABG (1.04 [0.75-1.45], p=0.82 and 1.21 [0.75-1.95], p=0.44). Furthermore, Stratified analysis using the SYNTAX Score [low (<23), intermediate (23 to 32), and high (≥33)] demonstrated that risk for death was not different between PCI and CABG regardless of the SYNTAX Sore. During the 5-year follow-up, 201 patients (52%) died. Among them, 144 patients (72%) died of non-cardiac morbidities such as infection, stroke, gastrointestinal complications, uremia, and malignancy.
Conclusions: 5-year overall mortality in patients with dialysis with complex coronary disease is very high (>50%). CABG may reduce the risk of myocardial infarction and repeated revascularization compared with PCI with DES. However, CABG could not demonstrate the long-term survival benefit compared with PCI regardless of the SYNTAX Score stratification. That may be because patients requiring dialysis are often associated with non-cardiac complications and death.
- © 2013 by American Heart Association, Inc.