Periprocedural Outcomes of Elective Revascularization for Ischemic Cardiomyopathy with Percutaneous Coronary Intervention (PCI) vs. Coronary Artery Bypass Graft (CABG) in Patients with Renal Dysfunction

Abstract

Background The degree of left ventricular dysfunction has a well-defined impact on survival in patients with ischemic cardiomyopathy. The clinical benefit from revascularization is difficult to ascertain and depends on the amount of hibernating myocardium at risk. The decision to achieve complete myocardial revascularization by CABG vs. PCI in patients with chronic kidney disease (CKD) is complex and typically based on clinical gestalt with limited literature available on in-hospital mortality, cost, and outcomes for both strategies. Hypothesis Patients with ischemic cardiomyopathy undergoing revascularization with CABG will have worse periprocedural outcomes and higher cost compared to PCI. Methods All hospitalizations of patients with CKD (ICD-9 diagnosis codes 585.X) and systolic heart failure (diagnosis codes 428.1, 428.2x, 428.4x, or 428.9) were identified from the 2006-2014 National Inpatient Sample. Within this cohort, patients with PCI (ICD-9 procedure codes 36.06 or 36.07) and with CABG (procedure code 36.1) were compared in terms of demographics, comorbidities, in-hospital mortality, length of stay (LOS), and cost of care. Trends over time were determined using the Cochran Armitage and Cuzick tests. Multivariate models were constructed with weighted logistic and linear regression (gamma function) using the NIS discharge weights and adjusted for age and comorbidities including hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and family history of heart disease. Results Overall, trends in in-hospital mortality (p=0.25) and LOS (p=0.91) remained unchanged for the PCI group, but decreased in the CABG group (p Conclusions Revascularization can be successfully achieved by both PCI and CABG in CKD patients. However, PCI appears to have lower in-hospital mortality, fewer postoperative complications, shorter LOS, and significant cost savings.