Prognostic analysis of drug-eluting stent implantation and coronary artery bypass grafting in patients with unprotected left main coronary artery disease complicated with chronic renal failure

Abstract

To analyze the long-term prognosis of undergoing drug-eluting stent implantation (DES) or coronary artery bypass grafting (CABG) in patients with unprotected left main (ULM) coronary artery disease complicated with chronic renal failure (CRF). Patients with UML coronary artery disease complicated with CRF admitted to the department of cardiology intensive care unit (ICU) and cardiac surgery ICU of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled. According to the estimated glomerular filtration rate (eGFR), the patients were divided into two layers, and the clinical characteristics of DES patients and CABG patients were analyzed. Log-Rank method and Cox regression were used to analyze the coronary artery disease and long-term clinical prognosis of patients with two surgical strategies. A total of 353 patients were enrolled, including 150 patients with eGFR < 45 mL×min-1×1.73 m-2 (DES 67 cases, CABG 83 cases), eGFR 45-59 mL×min-1×1.73 m-2 in 203 cases (DES 80 cases, CABG 123 cases). In terms of demography and clinical history, compared with CABG group, DES group had lower proportion of complete revascularization and lower proportion of chronic totalocclusion (CTO) and multi vessel disease in each eGFR level. All patients were followed up for an average of (30.74±15.05) months. Log-Rank analysis showed that there was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events (MACCE), all-cause death, cardiogenic death and stroke between DES group and CABG group in each eGFR level. In eGFR 45-59 mL×min-1×1.73 m-2, the proportion of target vessel revascularization (TVR) in DES group was higher than that in CABG group (18.8% vs. 0.8%, P < 0.01); in eGFR < 45 mL×min-1×1.73 m-2, the incidence of myocardial infarction in DES group was higher than that in CABG group (10.4% vs. 1.2%, P < 0.05). Cox analysis showed that after adjusting for age, gender, history of hypertension, diabetes, left ventricular ejection fraction, smoking history, previous cerebrovascular disease, complete revascularization, multiple vessel disease and CTO, TVR proportion in DES group was still higher than that in CABG group in eGFR 45-59 mL×min-1×1.73 m-2 [hazard ratio (HR) = 46.463, 95% confidence interval (95%CI) was 4.558-473.693, P = 0.001]; in eGFR < 45 mL×min-1×1.73 m-2, the incidence of myocardial infarction in DES group was still higher than that in CABG group (HR = 14.098, 95%CI was 1.123-176.988, P = 0.040), there was no difference in TVR proportion between the two methods. eGFR < 45 mL×min-1×1.73 m-2 is an independent risk factor for DES in ULM patients. DES is safe and effective for ULM patients with CRF, but for patients with more severe CRF (eGFR < 45 mL×min-1×1.73 m-2), there was more myocardial infarction in DES group than that in CABG group, which should be carefully selected.