Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent. The rates of 30-day and long-term mortality, 30-day major adverse cardiovascular events, and hemodialysis dependence after revascularization were compared between these 2 groups by computing the hazard ratios from a Cox proportional hazards model and adjusting them for the baseline covariates and propensity score. After either CABG or PCI, 2.4% of the patients with non-HD CKD were hemodialysis dependent. Compared to PCI, CABG was associated with postoperative hemodialysis dependence (odds ratio 3.2, 95% confidence interval 1.1 to 9.3; p <0.001). However, among patients with non-HD CKD and 3-vessel CAD, those who underwent CABG tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61, 95% confidence interval 0.36 to 1.03; p = 0.06). In the patients with non-HD CKD treated for 2-vessel CAD, those who underwent CABG or PCI had a similar long-term mortality risk (hazard ratio 1.12, 95% confidence interval 0.52 to 2.34; p = 0.7). In conclusion, in patients with non-HD CKD and multivessel CAD, CABG led to better survival than PCI with drug-eluting stents, but CABG patients had a greater short-term risk of requiring permanent hemodialysis.

Ashrith G ，Lee VV ，Elayda MA ，Reul RM ，Wilson JM ... -  《-》

Long-term mortality after percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass surgery for the treatment of multivessel coronary artery disease.

Park DW ，Yun SC ，Lee SW ，Kim YH ，Lee CW ，Hong MK ，Kim JJ ，Choo SJ ，Song H ，Chung CH ，Lee JW ，Park SW ，Park SJ ... -  《-》

Coronary artery bypass surgery versus percutaneous coronary artery intervention in patients on chronic hemodialysis: does a drug-eluting stent have an impact on clinical outcome?

Manabe S ，Shimokawa T ，Fukui T ，Fumimoto KU ，Ozawa N ，Seki H ，Takanashi S ... -  《-》

Coronary artery bypass surgery is superior to percutaneous coronary intervention with drug-eluting stents for patients with chronic renal failure on hemodialysis.

Improvements in the results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with all forms of coronary artery disease. The purpose of this study was to compare the midterm clinical results of coronary artery bypass surgery (CABG) and PCI with DES in patients with chronic renal failure on hemodialysis. From January 2002 to December 2006, 29 patients underwent CABG, and 75 patients underwent PCI with DES. For CABG, 24 patients had off-pump surgery. The mean follow-up was 32.0 +/- 22.0 months for CABG and 23.5 +/- 14.8 months for PCI. Survival, cardiac death, major adverse cardiac events (cardiac death, myocardial infarction, revascularization), and target lesion revascularization were analyzed using the Kaplan-Meier method. Preoperative characteristics and risk factors were compatible between the groups except for the European System for Cardiac Operative Risk Evaluation (7.3 +/- 2.7 for CABG and 5.0 +/- 2.4 for PCI, p < 0.0001) and the presence of a left main trunk lesion (53.3% for CABG and 18.7% for PCI). Thirty-day mortality was 3.3% for CABG and 4.0% for PCI. The 2-year survival rate was 84.0% for CABG and 67.6% for PCI (p = 0.0271). The cardiac death-free curve at 2 years was 100% for CABG and 84.1% for PCI (p = 0.0122). The major adverse cardiac events-free rate at 2 years was 75.8% for CABG and 31.5% for PCI (p < 0.0001). During the follow-up period, there were 6 late deaths in the CABG group and 27 late deaths (including 6 sudden deaths) in the PCI group. Coronary artery bypass grafting was superior to PCI with DES in patients with chronic renal failure on hemodialysis in terms of long-term outcomes for cardiac death, major adverse cardiac events, and target lesion revascularization. The DES carried a higher risk for sudden death, which might be associated with stent thrombosis.

Sunagawa G ，Komiya T ，Tamura N ，Sakaguchi G ，Kobayashi T ，Murashita T ... -  《-》

Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.

Javaid A ，Steinberg DH ，Buch AN ，Corso PJ ，Boyce SW ，Pinto Slottow TL ，Roy PK ，Hill P ，Okabe T ，Torguson R ，Smith KA ，Xue Z ，Gevorkian N ，Suddath WO ，Kent KM ，Satler LF ，Pichard AD ，Waksman R ... -  《-》