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Coronary Artery Bypass Grafting vs. Drug-Eluting Stent Implantation for Multivessel Disease in Patients with Chronic Kidney Disease
Korean Circulation Journal ; : 354-360, 2017.
Artículo en Inglés | WPRIM | ID: wpr-76472
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.
Asunto(s)

Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Enfermedad de la Arteria Coronaria / Puente de Arteria Coronaria / Estudios de Seguimiento / Mortalidad / Enfermedad Coronaria / Vasos Coronarios / Trasplantes / Accidente Cerebrovascular / Insuficiencia Renal / Insuficiencia Renal Crónica Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Humanos Idioma: Inglés Revista: Korean Circulation Journal Año: 2017 Tipo del documento: Artículo

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Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Enfermedad de la Arteria Coronaria / Puente de Arteria Coronaria / Estudios de Seguimiento / Mortalidad / Enfermedad Coronaria / Vasos Coronarios / Trasplantes / Accidente Cerebrovascular / Insuficiencia Renal / Insuficiencia Renal Crónica Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Humanos Idioma: Inglés Revista: Korean Circulation Journal Año: 2017 Tipo del documento: Artículo