Abduzhappar Gaipov1,2, Miklos Z Molnar3,4,5, Praveen K Potukuchi1, Keiichi Sumida1,6, Robert B Canada1, Oguz Akbilgic7, Kairat Kabulbayev8, Zoltan Szabo9,10, Santhosh K G Koshy11, Kamyar Kalantar-Zadeh12, Csaba P Kovesdy1,13. 1. Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States. 2. Department of Extracorporeal Hemocorrection, National Scientific Medical Research Center, Astana, Kazakhstan. 3. Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA. 4. Department of Surgery and Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 5. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. 6. Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan. 7. Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States. 8. Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan. 9. Department of Cardiothoracic Surgery and Anesthesia, Linköping University Hospital, Linkoping, Sweden. 10. Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 11. Division of Cardiology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States. 12. Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA, United States. 13. Nephrology Section, Memphis VA Medical Center, Memphis, TN, United States.
Abstract
Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD). However, the optimal strategy for coronary artery revascularization in advanced CKD patients who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, socio-demographics, comorbidities and medications. Results: 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 79% were white, 19% were African Americans, and 84% were diabetics. The all-cause post-dialysis mortality rates after CABG and PCI were 229/1000 patient-years (PY) [95% CI: 205-256] and 311/1000PY [95% CI: 272-356], respectively. Compared to PCI, patients who underwent CABG had 34% lower risk of death [multivariable adjusted Hazard Ratio (95% CI) 0.66 (0.51-0.86), p=0.002] after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure and diabetes. Conclusion: CABG in advanced CKD patients was associated lower risk of death after initiation of dialysis compared to PCI.
Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD). However, the optimal strategy for coronary artery revascularization in advanced CKDpatients who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, socio-demographics, comorbidities and medications. Results: 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 79% were white, 19% were African Americans, and 84% were diabetics. The all-cause post-dialysis mortality rates after CABG and PCI were 229/1000 patient-years (PY) [95% CI: 205-256] and 311/1000PY [95% CI: 272-356], respectively. Compared to PCI, patients who underwent CABG had 34% lower risk of death [multivariable adjusted Hazard Ratio (95% CI) 0.66 (0.51-0.86), p=0.002] after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure and diabetes. Conclusion: CABG in advanced CKDpatients was associated lower risk of death after initiation of dialysis compared to PCI.
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