|
KMID : 0368120170470030354
|
|
Korean Circulation Journal
2017 Volume.47 No. 3 p.354 ~ p.360
|
|
|
Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease
|
|
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
|
|
|
Abstract
|
|
|
Background and Objectives: 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.
Subjects and Methods: We analyzed 2108 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m2) 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.
Results: 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).
Conclusion: 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.
|
|
|
KEYWORD
|
|
|
Coronary artery bypass, Coronary disease, Percutaneous coronary intervention, Renal insufficiency
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
   
|
|