Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease

  • Kang, Se Hun (Department of Cardiology, CHA Bundang Medical Center, CHA University) ;
  • Lee, Cheol Whan (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun, Sung-Cheol (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Pil Hyung (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Jung-Min (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Duk-Woo (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Soo-Jin (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Seung-Whan (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hak (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seong-Wook (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seung-Jung (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2016.12.25
  • Accepted : 2016.02.14
  • Published : 2017.05.31
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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 <$60mL/min/1.73m^2$) 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 $66.9{\pm}9.1$ 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.

Keywords

References

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