Long-term Outcomes of Dialysis Patients After Coronary Revascularization: A Population-based Cohort Study in Taiwan

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• 作者：Chu-lin Chou^a ; ^&lowast ; ; Tsung-cheng Hsieh^a ; ^&lowast ; ; Chih-hsien Wang^b ; Tsung-hsing Hung^c ; ^d ; Yu-hsien Lai^b ; Yi-ya Chen^b ; Yu-li Lin^b ; Chiu-huang Kuo^b ; Ya-ju Wu^e ; Te-chao Fang^a ; ^b ; ^d ; ^{fangtechao@yahoo.com.tw" class="auth_mail}
• 关键词：Coronary artery bypass grafting ; Dialysis ; Percutaneous transluminal coronary angioplasty ; Stent
• 刊名：Archives of Medical Research
• 出版年：February, 2014
• 年：2014
• 卷：45
• 期：2
• 页码：188-194
• 全文大小：409 K

文摘

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Background and Aims

The outcomes of Chinese patients undergoing dialysis after coronary revascularization are unknown. We examined the outcomes of Taiwanese dialysis patients after coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), or coronary stenting.

Methods

Using data from the National Health Research Institute database, we determined the outcomes of 1,287 dialysis patients who underwent initial coronary revascularization between 1997 and聽2008.

Results

The 7-year overall survival rates were 69 卤 4%, 68 卤 3%, and 57 卤 2% for the CABG, stent, and PTCA patients (p聽= 0.001), respectively. After demographic and comorbidity adjustment, hazard ratios (HRs) for all-cause death in the CABG (vs. PTCA) and stent (vs. PTCA) patients were 0.695 (p聽= 0.015) and 0.721 (p聽= 0.009). Additionally, no significant difference in all-cause death was found between the CABG and stent patients. Moreover, the 鈮?5-year-old CABG group patients and the <65-year-old coronary stent group patients showed better survival than the PTCA group patients. Compared with the PTCA and CABG groups, the coronary stent group was significantly associated with a higher risk for recurrent acute myocardial infarction (AMI). Based on age stratification, the 鈮?5-year-old stent group had a higher risk for recurrent AMI than the PTCA group (HR, 1.562; p聽= 0.026).

Conclusions

Chinese patients undergoing dialysis who underwent CABG or coronary stenting had better survival than those who underwent PTCA. Moreover, being 鈮?5 years old, CABG shows better survival compared with PTCA; being <65 years old, coronary stenting show better survival compared with PTCA.