Abstract 17592: Coronary Revascularization in Patients With Chronic Kidney Disease and Stable Ischemic Heart Disease: Utilization and Association With Long-term Survival
Introduction: Clinical trials of revascularization versus medical management in stable ischemic heart disease (SIHD) support a conservative approach. However, chronic kidney disease (CKD) patients have been under-represented despite their heightened risk of death.
Hypothesis: We examined the utilization, characteristics, and clinical outcomes of coronary revascularization compared to medical management across a range of kidney function in patients with SIHD.
Methods: We studied 17, 910 SIHD patients with flow-limiting coronary disease using the APPROACH prospective registry in Alberta, Canada between January 1 1999 to March 31, 2014. Comparisons were made between patients with dialysis-dependent CKD, non-dialysis CKD (eGFR <30, 30-45, or 45-60 ml/min), and no CKD (eGFR >60ml/min). Long-term survival by treatment group (revascularization ≤ 3 months of angiogram [CABG or PCI] versus conservative management) was examined using Cox proportional-hazards models.
Results: Of our study cohort, 13.9% (n=2490) had CKD. These patients were older (except dialysis CKD), less commonly male and had higher rates of diabetes and prior heart failure. Revascularization was less commonly performed in CKD (Table). Over a median of 8.0 (IQR 3.2) years, revascularization was associated with lower risk of mortality at all stages of CKD (p-interaction 0.0096) (dialysis-dependent: adjusted HR 0.32, 95%CI 0.17-0.58; eGFR<30: adjusted HR 0.68, 95%CI 0.40-1.15; eGFR 30-45: adjusted HR 0.64, 95%CI 0.46-0.90; eGFR 45-60: adjusted HR 0.56, 95%CI 0.44-0.70) (Figure).
Conclusion: In SIHD, our results confirm the high mortality associated with CKD. Substantially lower rates of revascularization were observed, despite the lower risk of mortality associated with revascularization. Our results require validation in a randomized trial focused on CKD patients.
Author Disclosures: J. Shavadia: None. M. James: None. D. Southern: None. R. Welsh: None. K. Bainey: None.
- © 2016 by American Heart Association, Inc.