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Observational Study
. 2019 Mar;157(3):976-983.e7.
doi: 10.1016/j.jtcvs.2018.08.107. Epub 2018 Sep 27.

Predialysis coronary revascularization and postdialysis mortality

Abduzhappar Gaipov  1   2 , Miklos Z Molnar  3   4   5 , Praveen K Potukuchi  1 , Keiichi Sumida  1   6 , Robert B Canada  1 , Oguz Akbilgic  7 , Kairat Kabulbayev  8 , Zoltan Szabo  9   10 , Santhosh K G Koshy  11 , Kamyar Kalantar-Zadeh  12 , Csaba P Kovesdy  1   13
Affiliations
Observational Study

Predialysis coronary revascularization and postdialysis mortality

Abduzhappar Gaipov et al. J Thorac Cardiovasc Surg. 2019 Mar.

Abstract

Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD). However, the optimal strategy for coronary artery revascularization in advanced CKD patients who transition to ESRD is unclear.

Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, socio-demographics, comorbidities and medications.

Results: 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 79% were white, 19% were African Americans, and 84% were diabetics. The all-cause post-dialysis mortality rates after CABG and PCI were 229/1000 patient-years (PY) [95% CI: 205-256] and 311/1000PY [95% CI: 272-356], respectively. Compared to PCI, patients who underwent CABG had 34% lower risk of death [multivariable adjusted Hazard Ratio (95% CI) 0.66 (0.51-0.86), p=0.002] after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure and diabetes.

Conclusion: CABG in advanced CKD patients was associated lower risk of death after initiation of dialysis compared to PCI.

Keywords: all-cause mortality; chronic kidney disease; coronary artery bypass grafting; end-stage renal disease; percutaneous coronary interventions.

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Conflict of interest statement

Disclosures: None of the authors have relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the patients’ selection. Abbreviations: CABG, coronary artery bypass grafting; PCI, percutaneous coronary interventions.
Figure 2.
Figure 2.
Probability of Survival in the CABG and PCI group in the entire cohort Abbreviations: CABG, coronary artery bypass grafting; PCI, percutaneous coronary interventions.
Figure 3.
Figure 3.
Association between post-ESRD all-cause mortality and type of revascularization (CABG vs PCI (reference)) using Cox proportional hazards models in selected subgroups. Abbreviations: CABG, coronary artery bypass grafting; PCI, percutaneous coronary interventions; ESRD, end-stage renal disease.
Central picture
Central picture
Retrospective cohort study design and main outcomes
See this image and copyright information in PMC

References

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