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Predialysis coronary revascularization and postdialysis mortality
Natl Sci Med Res Ctr, Kazakhstan.
Methodist Univ Hosp, TN USA; Semmelweis Univ, Hungary.
Natl Sci Med Res Ctr, Kazakhstan.
Natl Sci Med Res Ctr, Kazakhstan; Toranomon Hosp Kajigaya, Japan.
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2019 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, no 3, p. 976-+Article in journal (Refereed) Published
Abstract [en]

Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 +/- 8 years, 99% of patients were male, 79% were white, 19% were African American, and 84% had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95% confidence interval [CI], 205-256) and 311 per 1000 patient years (95% CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34% lower risk of death (multivariable adjusted hazard ratio, 0.66; 95% CI, 0.51-0.86, P = .002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2019. Vol. 157, no 3, p. 976-+
Keywords [en]
all-cause mortality; coronary artery bypass grafting; percutaneous coronary interventions; chronic kidney disease; end-stage renal disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-154988DOI: 10.1016/j.jtcvs.2018.08.107ISI: 000458822000073OAI: oai:DiVA.org:liu-154988DiVA, id: diva2:1297558
Note

Funding Agencies|National Institutes of Health (NIH) [5U01DK102163]; US Department of Veterans Affairs; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center [SDR 02-237, 98-004]; International Society of Nephrology (ISN) research fellowship program; ISN

Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-03-20

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Szabo, Zoltán
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Thoracic and Vascular Surgery
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