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Survival after coronary revascularization among patients with kidney disease

Brenda R Hemmelgarn1, Danielle Southern, Bruce F Culleton

  • 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada. brenda.hemmelgarn@calgaryhealthregion.ca.

Circulation
|September 29, 2004
PubMed

Insights

Coronary artery bypass grafting (CABG) improved survival for kidney disease patients, including those on dialysis. Percutaneous coronary intervention (PCI) also benefited dialysis patients but not those with non-dialysis-dependent kidney disease compared to no revascularization.

Area of Science:

  • Cardiology
  • Nephrology
  • Outcomes Research

Background:

  • Optimal revascularization strategy for patients with kidney disease remains unclear.
  • Kidney function varies, impacting treatment decisions and outcomes.
  • Three patient groups were studied: dialysis-dependent kidney disease, non-dialysis-dependent kidney disease, and a reference group.

Purpose of the Study:

  • To compare survival rates among different revascularization strategies in patients with varying degrees of kidney function.
  • To determine the effectiveness of Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) versus no revascularization in kidney disease patients.

Main Methods:

  • Retrospective analysis of the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) database.
  • Survival data analyzed for 40,374 patients, including 662 dialysis-dependent and 750 non-dialysis-dependent kidney disease patients.
  • Adjusted 8-year survival rates compared for CABG, PCI, and no revascularization (NR) across kidney function categories.

Main Results:

  • In the reference group, CABG (85.5%) and PCI (80.4%) showed significantly better survival than NR (72.3%).
  • In non-dialysis kidney disease patients, CABG (45.9%) improved survival versus NR (29.7%), but PCI (32.7%) did not significantly differ from NR.
  • In dialysis-dependent kidney disease patients, CABG (44.8%) and PCI (41.2%) were associated with better survival than NR (30.4%).

Conclusions:

  • CABG is associated with improved survival across all kidney function levels compared to no revascularization.
  • PCI offers survival benefits for reference and dialysis-dependent kidney disease patients but not for non-dialysis-dependent kidney disease patients.
  • The presence of kidney disease or dialysis dependence should not preclude revascularization, especially CABG.
Abstract

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