Abstract
ACS patients with renal dysfunction tend to have a poorer prognosis than those with normal renal function. This retrospective cohort study was performed using The Second Drug-Eluting Stent Impact on Revascularization Registry, a retrospective registry, to evaluate the time-dependent relative risk of revascularization strategies in ACS patients with renal dysfunction. The study demonstrated that the short-term MACCE rate was lower after PCI than CABG. However, there was no significant difference in long-term MACCE rate. Subgroup analyses based on the degree of renal dysfunction resulted in similar findings. The revascularization strategy was identified as a time-dependent covariate by the time-dependent Cox model, and the regression coefficient was ‘−1.124 + 0.344 × ln (time + 1)’. For the entire object group and the separate subgroups, PCI was initially associated with a lower hazard for MACCE than CABG after revascularization, then the hazard ratio increases with time. In conclusion, the hazard ratio for MACCE in PCI relative to CABG is time-dependent. PCI tends to have a lower risk for MACCE than CABG in the short-term, then the hazard ratio increases with time.
Highlights
We identified 2923 ACS patients with renal dysfunction who underwent either PCI or CABG successfully after excluding patients with missing renal function measurements
There were no significant differences between the PCI and CABG groups except for gender, hypertension, hemoglobin, blood urea nitrogen (BUN), high density lipoprotein cholesterol (HDL-C), old myocardial infarction (OMI), ACS and the degree of renal dysfunction
Hemoglobin and HDL-C levels were lower in the CABG group, and BUN was higher in the CABG group
Summary
This study aims to evaluate the fluctuant relative risk of revascularization strategies for ACS patients with renal dysfunction, for the purpose of searching for optimal revascularization strategy in different situations
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