Propensity-matched comparison of drug-eluting stent implantation and coronary artery bypass graft surgery in chronic hemodialysis patients

Abstract

Cardiovascular disease is an important cause of death in patients with end-stage renal disease. Although coronary artery bypass graft (CABG) surgery and drug-eluting stent (DES) implantation have been compared in chronic hemodialysis patients, the results are unclear. The study population consisted of chronic hemodialysis patients (dialysis duration >6months) with coronary artery disease who underwent DES implantation or CABG at the Asan Medical Center (Seoul, Korea) between January 1, 2003, and February 28, 2006. We followed them until December, 2012. The mean follow-up was 50.91±31.86months for DES patients and 50.63±36.43months for CABG patients. Primary end points were major adverse cardiac and cerebral events (MACCE). Propensity-score matching was used to reduce selection bias and variable characteristics. Of 87 chronic hemodialysis patients with coronary artery disease, 44 underwent DES implantation and 43 underwent CABG surgery. Multivessel disease patients were 70.45% in the DES group and 95.35% in the CABG group. After propensity score adjustment, the MACCE-free survival was significantly higher in the CABG group than in the DES group (HR 3.265; 95% CI 1.357-7.858; p=0.008), but overall survival did not differ between the groups (HR 0.968; 95% CI 0.267-3.507; p=0.960). We found that, compared with DES, CABG showed significantly better MACCE-free survival in chronic hemodialysis patients.