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Treatment outcomes for ischemic heart disease in dialysis-dependent patients

Alexander Yeates1, Carmel Hawley, Julie Mundy

  • 1Department of Cardiothoracic Surgery, Princess Alexandra Hospital, and Department of Medicine, University of Queensland, Brisbane, Australia. asyeates@gmail.com

Asian Cardiovascular & Thoracic Annals
|June 22, 2012
PubMed

Insights

For dialysis patients with ischemic heart disease, coronary artery bypass grafting (CABG) offers better quality of life and fewer adverse events than stenting. Treatment decisions should be guided by symptoms and coronary anatomy.

Area of Science:

  • Cardiology
  • Nephrology
  • Outcomes Research

Background:

  • Ischemic heart disease (IHD) is a leading cause of death in dialysis-dependent patients.
  • Optimal treatment strategies for IHD in this population remain unclear, despite common interventions like revascularization and medical management.

Purpose of the Study:

  • To compare the outcomes of different interventions for dialysis-dependent patients suffering from ischemic heart disease.

Main Methods:

  • A prospective study of 90 dialysis-dependent patients with IHD from 1999-2009.
  • Patients were divided into three groups: best medical management (35), percutaneous coronary angioplasty with stenting (31), and coronary artery bypass grafting (24).
  • Median follow-up was 24 months, utilizing Kaplan-Meier analysis for time-to-event data.

Main Results:

  • Both stenting and CABG showed lower risks of adverse outcomes compared to medical management.
  • Overall mortality was 44.4%, with smoking and logistic EuroSCORE predicting mortality.
  • Coronary artery bypass grafting resulted in significantly better quality of life and physical function compared to stenting or medical management, despite similar overall mortality rates.

Conclusions:

  • Dialysis-dependent patients with IHD experience poor survival even after interventions.
  • Coronary artery bypass grafting demonstrates superior outcomes in terms of composite adverse events and quality of life compared to stenting.
  • Treatment choices should be individualized based on patient symptoms and coronary anatomy.
Abstract

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