Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

David M. Charytan, Manisha Desai, Maya Mathur, Noam M. Stern, Maria M. Brooks, Lukasz J. Krzych, Gerhard C. Schuler, Jan Kaehler, Alfredo M. Rodriguez-Granillo, Whady Hueb, Barnaby C Reeves, Holger Thiele, Alfredo E. Rodriguez, Piotr P. Buszman, Paweł E. Buszman, Rie Maurer, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle (Academic Journal)peer-review

21 Citations (Scopus)
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Abstract

Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD, and unbiased data comparing coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were stage 3b–5 CKD. Among individuals with stage 3 to 5 CKD, survival through 5 years was not different after CABG compared with PCI (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.67–1.46) or stage 3b–5 CKD (HR 1.29, CI 0.68–2.46). However, CKD modified the impact on survival free of myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (HR 0.97, CI 0.80–1.17), but was significantly lower after CABG in stage 3–5 CKD (HR 0.49, CI 0.29–0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09–0.58). Repeat revascularization was reduced after CABG compared with PCI regardless, of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4–5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without affecting survival in these patients.
Original languageEnglish
Pages (from-to)411-421
Number of pages11
JournalKidney International
Volume90
Issue number2
Early online date1 Jun 2016
DOIs
Publication statusPublished - Aug 2016

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research

Keywords

  • chronic kidney disease
  • coronary artery disease
  • coronary revascularization
  • myocardial infarction

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