- 作者：Sripal Bangalore ; MD ; MHA&lowast ; ; sripalbangalore@gmail.com" class="auth_mail" title="E-mail the corresponding author ; Yu Guo ; MA&lowast ; ; Zaza Samadashvili ; MD&dagger ; ; Saul Blecker ; MD ; MHS&lowast ; ; Jinfeng Xu ; PhD&lowast ; ; Edward L. Hannan ; PhD ; MS&dagger ;
- 关键词：chronic kidney disease ; multivessel disease ; percutaneous coronary intervention
- 刊名：Journal of the American College of Cardiology
- 出版年：2015
- 出版时间：15 September 2015
- 年：2015
- 卷：66
- 期：11
- 页码：1209-1220
- 全文大小：1065 K
Objectives
This study evaluated outcomes of PCI versus CABG in patients with CKD.
Methods
Patients with CKD who underwent PCI using everolimus-eluting stents were propensity-score matched to patients who underwent isolated CABG for multivessel coronary disease in New York. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization.
Results
Of 11,305 patients with CKD, 5,920 patients were propensity-score matched. In the short term, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.35 to 0.87), stroke (HR: 0.22; 95% CI: 0.12 to 0.42), and repeat revascularization (HR: 0.48; 95% CI: 0.23 to 0.98) compared with CABG. In the longer term, PCI was associated with a similar risk of death (HR: 1.07; 95% CI: 0.92 to 1.24), higher risk of MI (HR: 1.76; 95% CI: 1.40 to 2.23), a lower risk of stroke (HR: 0.56; 95% CI: 0.41 to 0.76), and a higher risk of repeat revascularization (HR: 2.42; 95% CI: 2.05 to 2.85). In the subgroup with complete revascularization with PCI, the increased risk of MI was no longer statistically significant (HR: 1.18; 95% CI: 0.67 to 2.09). In the 243 matched pairs of patients with end-stage renal disease on hemodialysis, PCI was associated with significantly higher risk of death (HR: 2.02; 95% CI: 1.40 to 2.93) and repeat revascularization (HR: 2.44; 95% CI: 1.50 to 3.96) compared with CABG.
Conclusions
In patients with CKD, CABG is associated with higher short-term risk of death, stroke, and repeat revascularization, whereas PCI with everolimus-eluting stents is associated with a higher long-term risk of repeat revascularization and perhaps MI, with no long-term mortality difference. In the subgroup on dialysis, the results favored CABG over PCI.