Abstract
Objectives To evaluate the optimal revascularization strategy for patients with coronary artery disease (CAD) and end stage renal disease (ESRD) in the drug-eluting stent (DES) era. Methods One hundred and twelve patients with ESRD treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) were enrolled from 2007 to 2017. All patients were dialysis-dependent, of which 26 received CABG and 86 underwent PCI. The primary endpoint was all-cause mortality. Secondary endpoints were major adverse cardiovascular events including myocardial infarction, stroke, repeat revascularization, and death. Results The CABG group had a higher prevalence of left main CAD (57.7% vs. 11.6%, p < .01) compared with PCI group. The short-term (within 30 days after the procedure) risk of death was higher in CABG group compared with PCI group (15.4% vs. 1.2%, p < .05). The two groups exhibited similar rate of primary endpoints (50.0% vs. 40.7%, p = .37) and secondary endpoints (65.4% vs. 60.5%, p = .97) in long-term observation. Multivariate Cox regression showed that patients older than 65 or underwent peritoneal dialysis (PD) had significant higher rate of mortality than those under 65 (HR 2.85; 95% CI 1.20–6.85; p < .05) or underwent hemodialysis (HD) (HR 6.69; 95% CI 2.35–19.05; p < .01). Conclusions Among patients with CAD and dialysis-dependent chronic kidney disease (CKD), treatment with CABG or PCI with DES exhibited similar long-term outcomes. However, CABG was associated with higher short-term risk of death. Higher mortality was revealed in patients over 65 years and underwent PD.
Highlights
Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD), especially in patients with end-stage renal disease (ESRD) requiring dialysis [1,2]
The ESC guidelines recommend coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with ESRD and triple vessel coronary artery disease (CAD), based on the data derived from these studies [6,7]
We assess the short-term and long-term rates of major adverse events and survival rate in dialysis-dependent ESRD patients treated with CABG or PCI with drug-eluting stents (DES) in this retrospective, nonrandomized analysis
Summary
Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD), especially in patients with end-stage renal disease (ESRD) requiring dialysis [1,2]. According to the United States Renal Data System (USRDS), in dialysis patients, the annual rate of myocardial infarction and/or angina pectoris was 10% and all-cause mortality was 23.6% per year, of which cardiac disease accounting for 45% [3]. Despite the high risk of coronary artery disease (CAD), the current evidence for optimal revascularization strategy was predominantly based on observational studies instead of randomized clinical trials. The ESC guidelines recommend CABG over PCI in patients with ESRD and triple vessel CAD, based on the data derived from these studies [6,7]. We assess the short-term and long-term rates of major adverse events and survival rate in dialysis-dependent ESRD patients treated with CABG or PCI with DES in this retrospective, nonrandomized analysis
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