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Comparative Study
. 2012 Dec;23(12):2042-9.
doi: 10.1681/ASN.2012060554.

Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD

Tara I Chang  1 , David Shilane, Dhruv S Kazi, Maria E Montez-Rath, Mark A Hlatky, Wolfgang C Winkelmayer
Affiliations
Comparative Study

Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD

Tara I Chang et al. J Am Soc Nephrol. 2012 Dec.

Abstract

Thirty to sixty percent of patients with ESRD on dialysis have coronary heart disease, but the optimal strategy for coronary revascularization is unknown. We used data from the United States Renal Data System to define a cohort of 21,981 patients on maintenance dialysis who received initial coronary revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) between 1997 and 2009 and had at least 6 months of prior Medicare coverage as their primary payer. The primary outcome was death from any cause, and the secondary outcome was a composite of death or myocardial infarction. Overall survival rates were consistently poor during the study period, with unadjusted 5-year survival rates of 22%-25% irrespective of revascularization strategy. Using multivariable-adjusted proportional hazards regression, we found that CABG compared with PCI associated with significantly lower risks for both death (HR=0.87, 95% CI=0.84-0.90) and the composite of death or myocardial infarction (HR=0.88, 95% CI=0.86-0.91). Results were similar in analyses using a propensity score-matched cohort. In the absence of data from randomized trials, these results suggest that CABG may be preferred over PCI for multivessel coronary revascularization in appropriately selected patients on maintenance dialysis.

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Figures

Figure 1.
Figure 1.
Cohort assembly of 21,981 patients on maintenance dialysis undergoing initial coronary revascularization between 1997 and 2009 in the USRDS.
Figure 2.
Figure 2.
Distribution of initial multivessel revascularization type by index year among patients on maintenance dialysis in the USRDS. The proportion of patients undergoing multivessel CABG reached a nadir in 2006. After the introduction of drug-eluting stents in April 2003, the proportion of patients undergoing PCI who received a drug-eluting stent peaked at 87% in 2005. CABG, coronary artery bypass grafting; BMS, bare metal stent; DES, drug-eluting stent; Unk, unknown.
Figure 3.
Figure 3.
Survival rates at 1, 2, and 5 years after initial multivessel coronary revascularization for patients on maintenance dialysis in the USRDS by index year.
Figure 4.
Figure 4.
Kaplan-Meier curves showing unadjusted event-free probabilities and hazard ratios after multivessel CABG versus PCI in the propensity score-matched cohort of patients on maintenance dialysis. (A) Death. (B) Death or myocardial infarction.
Figure 5.
Figure 5.
Forest plot showing the adjusted hazard ratios (95% confidence interval) for multivessel CABG versus PCI in specified subgroups of patients on maintenance dialysis in the USRDS. Pint, P value for interaction term.
See this image and copyright information in PMC

References

    1. US Renal Data System: USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, NIDDK, National Institutes of Health, 2011
    1. Charytan D, Kuntz RE, Mauri L, DeFilippi C: Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients. Am J Kidney Dis 49: 409–416, 2007 - PubMed
    1. Kumar N, Baker CSR, Chan K, Duncan N, Malik I, Frankel A, Ashby DR, McLean A, Palmer A, Cairns TD, Taube D: Cardiac survival after pre-emptive coronary angiography in transplant patients and those awaiting transplantation. Clin J Am Soc Nephrol 6: 1912–1919, 2011 - PMC - PubMed
    1. Joki N, Hase H, Takahashi Y, Ishikawa H, Nakamura R, Imamura Y, Tanaka Y, Saijyo T, Fukazawa M, Inishi Y, Nakamura M, Yamaguchi T: Angiographical severity of coronary atherosclerosis predicts death in the first year of hemodialysis. Int Urol Nephrol 35: 289–297, 2003 - PubMed
    1. Coca SG, Krumholz HM, Garg AX, Parikh CR: Underrepresentation of renal disease in randomized controlled trials of cardiovascular disease. JAMA 296: 1377–1384, 2006 - PubMed

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