Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention

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• 作者：Hariharan Sugumar^a ; ¹ ; Terase F. Lancefield^a ; ¹ ; Nick Andrianopoulos^b ; ¹ ; Stephen J. Duffy^b ; ^c ; ¹ ; Andrew E. Ajani^b ; ^d ; ^e ; ¹ ; Melanie Freeman^a ; ¹ ; Brian Buxton^f ; ^g ; ¹ ; Angela L. Brennan^b ; ¹ ; Bryan P. Yan^b ; ^h ; ⁱ ; ¹ ; Diem T. Dinh^b ; ¹ ; Julian A. Smith^j ; ^k ; ¹ ; Kerrie Charter^a ; ¹ ; Omar Farouque^a ; ^e ; ¹ ; Christopher M. Reid^b ; ¹ ; David J. Clark^a ; ^e ; ¹ ; ^{clarkdavidj@hotmail.com" class="auth_mail} ; On behalf of the Australia ; New Zealand Society of Cardiac ; Thoracic Surgeons (ANZSCTS) & Melbourne Interventional Group (MIG)
• 关键词：Angioplasty ; Coronary disease ; Kidney ; Revascularization ; Surgery
• 刊名：International Journal of Cardiology
• 出版年：15 March, 2014
• 年：2014
• 卷：172
• 期：2
• 页码：442-449
• 全文大小：444 K

文摘

Background

Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD).

Methods and results

8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR) 鈮?#xA0;60 mL/min/1.73 m² (n = 1678:839), 30-59 mL/min/1.73 m² (n = 452:226) and < 30 mL/min/1.73 m² (n = 74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI) < 24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p = 0.84, 12.8% vs. 17.3% p = 0.12, and 23.0% vs. 40.5% p = 0.05 in the three strata, respectively. In patients with eGFR 鈮?#xA0;60 mL/min/1.73 m², long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p = 0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m², there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p = 0.001). In patients with eGFR < 30 mL/min/1.73 m², there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p = 0.17).

Conclusion

Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.