Careers  |  Sign In  |  Register  |   Twitter

Tradeoffs seen with CABG vs stenting in patients with kidney disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with chronic kidney disease not requiring hemodialysis present a dilemma when it comes to treating concomitant multivessel coronary artery disease (CAD): coronary artery bypass grafting offers the best survival rates, but there’s less risk of dialysis dependence subsequently if revascularization is achieved with a percutaneous intervention using drug-eluting stents.

That conclusion comes from a retrospective, nonrandomized study by Dr. James M. Wilson and colleagues at The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, involving 812 patients with chronic kidney disease who underwent coronary revascularization at the team’s institution.

Among the identified patients, 725 were not on dialysis initially; CABG was performed in 241 of them while the other 484 underwent PCI.

Those non-dialysis-dependent patients with 3-vessel CAD who underwent CABG “tended to have a lower long-term mortality rate than those who underwent PCI (hazard ratio 0.61; p=0.06)” the investigators report in the American Journal of Cardiology, made available online 18 June.

However, this benefit was offset by a greater risk of requiring permanent dialysis. Specifically, 4.2% of patients in the CABG subgroup became dialysis dependent compared with 1.5% of the PCI subgroup (p= 0.02). “Multivariate analysis showed that CABG independently predicted postprocedural hemodialysis dependence (OR 3.2; p=0.03),” according to the report.

In patients with 2-vessel disease, however, outcomes were similar with CABG and PCI.

“Our results,” the team concludes, “showed a definite trend toward improved long-term survival with CABG in patients with non-hemodialysis-dependent chronic kidney disease and 3-vessel CAD, mirroring the results of studies done in the general population of coronary revascularization patients.”


Short- and Long-Term Outcomes of Coronary Artery Bypass Grafting or Drug-Eluting Stent Implantation for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease

Am J Cardiol 2010.