Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

• Published in: Korean circulation journal Vol. 47; no. 3; pp. 354 - 360
• Main Authors: Kang, Se Hun, Lee, Cheol Whan, Yun, Sung-Cheol, Lee, Pil Hyung, Ahn, Jung-Min, Park, Duk-Woo, Kang, Soo-Jin, Lee, Seung-Whan, Kim, Young-Hak, Park, Seong-Wook, Park, Seung-Jung
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Cardiology 01.05.2017; 대한심장학회
• Subjects: Original; 내과학; Renal insufficiency; Percutaneous coronary intervention; Coronary artery bypass; Coronary disease
• ISSN: 1738-5520; 1738-5555
• DOI: 10.4070/kcj.2016.0439

There is currently a limited amount of data that demonstrate the optimal revascularization strategy for chronic kidney disease (CKD) patients with multivessel coronary artery disease (CAD). We compared the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for multivessel CAD in patients with CKD. We analyzed 2108 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m ) with multivessel CAD that were treated with PCI with DES (n=1165) or CABG (n=943). The primary outcome was a composite of all causes of mortality, myocardial infarction, or stroke. The mean age was 66.9±9.1 years. Median follow-up duration was 41.4 (interquartile range 12.1-75.5) months. The primary outcome occurred in 307 (26.4%) patients in the PCI group compared with 304 (32.2%) patients in the CABG group (adjusted hazard ratio [HR], 0.941; 95% confidence interval [CI], 0.79-1.12; p=0.493). The two groups exhibited similar rates of all-cause mortality (adjusted HR, 0.91; 95% CI, 0.77-1.09; p=0.295), myocardial infarction (adjusted HR, 1.86; 95% CI, 0.85-4.07; p=0.120) and stroke (3.2% vs. 4.8%; HR, 0.93; 95% CI, 0.57-1.61; p=0.758). However, PCI was associated with significantly increased rates of repeat revascularization (adjusted HR, 4.72; 95% CI, 3.20-6.96; p<0.001). Among patients with CKD and multivessel CAD, PCI with DES when compared with CABG resulted in similar rates of composite outcome of mortality from any cause, MI, or stroke; however, a higher risk of repeat revascularization was observed.