BACKGROUND: Randomized clinical trials comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) have largely excluded patients with chronic kidney disease (CKD), leading to uncertainty about the optimal coronary revascularization strategy. We sought to test the hypothesis that an initial strategy of CABG would be associated with lower risks of long-term mortality and cardiovascular morbidity compared with PCI for the treatment of multivessel coronary heart disease in the setting of CKD. METHODS: We created a propensity score-matched cohort of patients aged ≥30 years with no prior dialysis or renal transplant who received multivessel coronary revascularization between 1996 and 2008 within a large integrated health care delivery system in northern California. We used extended Cox regression to examine death from any cause, acute coronary syndrome, and repeat revascularization. RESULTS: Coronary artery bypass grafting was associated with a significantly lower adjusted rate of death than PCI across all strata of estimated glomerular filtration rate (eGFR) (in mL/min per 1.73 m(2)): the adjusted hazard ratio (HR) was 0.81, 95% CI 0.68 to 1.00 for patients with eGFR ≥60; HR 0.73 (CI 0.56-0.95) for eGFR of 45 to 59; and HR 0.87 (CI 0.67-1.14) for eGFR <45. Coronary artery bypass grafting was also associated with significantly lower rates of acute coronary syndrome and repeat revascularization at all levels of eGFR compared with PCI. CONCLUSIONS: Among adults with and without CKD, multivessel CABG was associated with lower risks of death and coronary events compared with multivessel PCI.
BACKGROUND: Randomized clinical trials comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) have largely excluded patients with chronic kidney disease (CKD), leading to uncertainty about the optimal coronary revascularization strategy. We sought to test the hypothesis that an initial strategy of CABG would be associated with lower risks of long-term mortality and cardiovascular morbidity compared with PCI for the treatment of multivessel coronary heart disease in the setting of CKD. METHODS: We created a propensity score-matched cohort of patients aged ≥30 years with no prior dialysis or renal transplant who received multivessel coronary revascularization between 1996 and 2008 within a large integrated health care delivery system in northern California. We used extended Cox regression to examine death from any cause, acute coronary syndrome, and repeat revascularization. RESULTS: Coronary artery bypass grafting was associated with a significantly lower adjusted rate of death than PCI across all strata of estimated glomerular filtration rate (eGFR) (in mL/min per 1.73 m(2)): the adjusted hazard ratio (HR) was 0.81, 95% CI 0.68 to 1.00 for patients with eGFR ≥60; HR 0.73 (CI 0.56-0.95) for eGFR of 45 to 59; and HR 0.87 (CI 0.67-1.14) for eGFR <45. Coronary artery bypass grafting was also associated with significantly lower rates of acute coronary syndrome and repeat revascularization at all levels of eGFR compared with PCI. CONCLUSIONS: Among adults with and without CKD, multivessel CABG was associated with lower risks of death and coronary events compared with multivessel PCI.
Authors: P W Serruys; F Unger; J E Sousa; A Jatene; H J Bonnier; J P Schönberger; N Buller; R Bonser; M J van den Brand; L A van Herwerden; M A Morel; B A van Hout Journal: N Engl J Med Date: 2001-04-12 Impact factor: 91.245
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Authors: L A Szczech; P J Best; E Crowley; M M Brooks; P B Berger; V Bittner; B J Gersh; R Jones; R M Califf; H H Ting; P J Whitlow; K M Detre; D Holmes Journal: Circulation Date: 2002-05-14 Impact factor: 29.690
Authors: Donal N Reddan; Lynda Anne Szczech; Robert H Tuttle; Linda K Shaw; Robert H Jones; Steve J Schwab; Mark Stafford Smith; Robert M Califf; Daniel B Mark; William F Owen Journal: J Am Soc Nephrol Date: 2003-09 Impact factor: 10.121
Authors: Brenda R Hemmelgarn; Danielle Southern; Bruce F Culleton; L Brent Mitchell; Merril L Knudtson; William A Ghali Journal: Circulation Date: 2004-09-27 Impact factor: 29.690
Authors: John K Roberts; Sunil V Rao; Linda K Shaw; Dianne S Gallup; Oscar C Marroquin; Uptal D Patel Journal: Am J Cardiol Date: 2017-02-09 Impact factor: 2.778
Authors: Abduzhappar Gaipov; Miklos Z Molnar; Praveen K Potukuchi; Keiichi Sumida; Robert B Canada; Oguz Akbilgic; Kairat Kabulbayev; Zoltan Szabo; Santhosh K G Koshy; Kamyar Kalantar-Zadeh; Csaba P Kovesdy Journal: J Thorac Cardiovasc Surg Date: 2018-09-27 Impact factor: 5.209