Document Detail


Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD.
MedLine Citation:
PMID:  23204445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Thirty to sixty percent of patients with ESRD on dialysis have coronary heart disease, but the optimal strategy for coronary revascularization is unknown. We used data from the United States Renal Data System to define a cohort of 21,981 patients on maintenance dialysis who received initial coronary revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) between 1997 and 2009 and had at least 6 months of prior Medicare coverage as their primary payer. The primary outcome was death from any cause, and the secondary outcome was a composite of death or myocardial infarction. Overall survival rates were consistently poor during the study period, with unadjusted 5-year survival rates of 22%-25% irrespective of revascularization strategy. Using multivariable-adjusted proportional hazards regression, we found that CABG compared with PCI associated with significantly lower risks for both death (HR=0.87, 95% CI=0.84-0.90) and the composite of death or myocardial infarction (HR=0.88, 95% CI=0.86-0.91). Results were similar in analyses using a propensity score-matched cohort. In the absence of data from randomized trials, these results suggest that CABG may be preferred over PCI for multivessel coronary revascularization in appropriately selected patients on maintenance dialysis.
Authors:
Tara I Chang; David Shilane; Dhruv S Kazi; Maria E Montez-Rath; Mark A Hlatky; Wolfgang C Winkelmayer
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  23     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-03     Completed Date:  2013-02-04     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2042-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass*
Coronary Disease / mortality,  surgery*
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic / complications*,  mortality
Male
Middle Aged
Percutaneous Coronary Intervention*
United States / epidemiology
Grant Support
ID/Acronym/Agency:
1R01AR057327/AR/NIAMS NIH HHS; 1R01DK090008/DK/NIDDK NIH HHS; 1R01DK090181/DK/NIDDK NIH HHS; 1R01DK095024/DK/NIDDK NIH HHS; 1R21DK077336/DK/NIDDK NIH HHS; 1R21DK089368/DK/NIDDK NIH HHS; HHSAA2900200500401//PHS HHS; HHSN268201100003C//PHS HHS
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