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An optimal strategy for coronary revascularization in patients with severe renal dysfunction.
MedLine Citation:
PMID:  25416698     Owner:  NLM     Status:  Publisher    
OBJECTIVES: The optimal strategy for coronary revascularization in patients with renal dysfunction remains undefined. As coronary artery bypass grafting (CABG) may be associated with higher mortality, less invasive percutaneous coronary intervention (PCI) may be preferred. To date, only limited information has been published regarding the effects of severe renal dysfunction on the outcome after CABG and PCI. To address this limitation, we analysed the clinical outcomes after CABG or PCI in patients with severe renal dysfunction not on chronic haemodialysis (HD).
METHODS: Among patients enrolled in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) Registry (a multicentre PCI/CABG registry in Japan), we identified 374 patients with multivessel disease and an estimated glomerular filtration rate <30 ml min(-1)1.73 m(-2) (PCI: n = 229, CABG: n = 145). Patients with acute myocardial infarction (n = 221) were excluded. Then, 77 pairs were selected for further analysis using propensity score matching. The median follow-up was 2.5 years.
RESULTS: In-hospital deaths following CABG (2, 2.6%) and PCI (4, 5.2%) did not differ significantly between groups (P = 0.46). Deterioration of renal function during hospitalization occurred in 9 and 5% of the CABG and PCI groups, respectively (P = 0.35). The rate of early introduction of HD did not differ between groups: CABG, 8%; PCI, 9%. Long-term survival was not different between CABG and PCI. However, freedom from major adverse cardiac and cerebrovascular events (log-rank, P = 0.003) and target lesion revascularization (log-rank, P = 0.003) was markedly higher in CABG.
CONCLUSIONS: Despite the marked progress in PCI technologies and techniques, CABG remains the standard treatment in patients with coronary artery disease complicated by severe renal dysfunction.
Tatsuhiko Komiya; Go Ueno; Kazushige Kadota; Kazuaki Mitsudo; Hitoshi Okabayashi; Noboru Nishiwaki; Michiya Hanyu; Takeshi Kimura; Shiro Tanaka; Akira Marui; Ryuzo Sakata;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-21
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-22     Completed Date:  -     Revised Date:  2014-11-25    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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