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. 2017 May;47(3):354-360.
doi: 10.4070/kcj.2016.0439. Epub 2017 May 25.

Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

Se Hun Kang  1 , Cheol Whan Lee  2 , Sung-Cheol Yun  3 , Pil Hyung Lee  2 , Jung-Min Ahn  2 , Duk-Woo Park  2 , Soo-Jin Kang  2 , Seung-Whan Lee  2 , Young-Hak Kim  2 , Seong-Wook Park  2 , Seung-Jung Park  2
Affiliations

Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

Se Hun Kang et al. Korean Circ J. 2017 May.

Abstract

Background and objectives: There is currently a limited amount of data that demonstrate the optimal revascularization strategy for chronic kidney disease (CKD) patients with multivessel coronary artery disease (CAD). We compared the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for multivessel CAD in patients with CKD.

Subjects and methods: We analyzed 2108 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m2) with multivessel CAD that were treated with PCI with DES (n=1165) or CABG (n=943). The primary outcome was a composite of all causes of mortality, myocardial infarction, or stroke. The mean age was 66.9±9.1 years.

Results: Median follow-up duration was 41.4 (interquartile range 12.1-75.5) months. The primary outcome occurred in 307 (26.4%) patients in the PCI group compared with 304 (32.2%) patients in the CABG group (adjusted hazard ratio [HR], 0.941; 95% confidence interval [CI], 0.79-1.12; p=0.493). The two groups exhibited similar rates of all-cause mortality (adjusted HR, 0.91; 95% CI, 0.77-1.09; p=0.295), myocardial infarction (adjusted HR, 1.86; 95% CI, 0.85-4.07; p=0.120) and stroke (3.2% vs. 4.8%; HR, 0.93; 95% CI, 0.57-1.61; p=0.758). However, PCI was associated with significantly increased rates of repeat revascularization (adjusted HR, 4.72; 95% CI, 3.20-6.96; p<0.001).

Conclusion: Among patients with CKD and multivessel CAD, PCI with DES when compared with CABG resulted in similar rates of composite outcome of mortality from any cause, MI, or stroke; however, a higher risk of repeat revascularization was observed.

Keywords: Coronary artery bypass; Coronary disease; Percutaneous coronary intervention; Renal insufficiency.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. Kaplan-Meier curves of cumulative incidence of (A) mortality, myocardial infarction, or stroke, (B) mortality, (C) myocardial infarction, and (D) stroke in patients treated with percutaneous coronary intervention (solid line) versus coronary artery bypass graft (dashed line). PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft.
Fig. 2
Fig. 2. Kaplan-Meier curves of cumulative incidence of mortality, myocardial infarction, or stroke in patients with (A) renal replacement therapy, (B) three-vessel disease, (C) diabetes mellitus, or (D) left ventricular ejection fraction <40, treated with percutaneous coronary intervention (solid line) versus coronary artery bypass graft (dashed line). PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft.
See this image and copyright information in PMC

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