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Coronary artery bypass graft type and outcomes in maintenance dialysis

D Shilane1, M A Hlatky, W C Winkelmayer

  • 1Department of Health Research and Policy, Stanford University School of Medicine Palo Alto, CA, USA - tichang@stanford.edu.

The Journal of Cardiovascular Surgery
|December 18, 2013
PubMed

Insights

Internal mammary artery (IMA) grafting offers better survival than saphenous vein graft (SVG) for patients with end-stage renal disease (ESRD) undergoing coronary artery bypass grafting. This finding holds true despite the generally low survival rates in this high-risk population.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Outcomes Research

Background:

  • Patients with end-stage renal disease (ESRD) on maintenance dialysis face a significant burden of coronary artery disease.
  • Internal mammary artery (IMA) grafting is linked to superior outcomes in non-dialysis patients compared to saphenous vein graft (SVG).
  • Limited data exists on the comparative effectiveness of IMA versus SVG in dialysis patients undergoing coronary revascularization.

Purpose of the Study:

  • To compare the effectiveness of multivessel coronary artery bypass grafting using IMA versus SVG in patients on maintenance dialysis in the United States.
  • To evaluate the impact of graft choice on mortality and cardiovascular morbidity in this specific patient cohort.

Main Methods:

  • A cohort study utilizing data from the United States Renal Data System.
  • Analysis involved Cox proportional hazards regression with multivariable adjustment and propensity-score matching.
  • Primary outcome was all-cause mortality; secondary outcome was a composite of non-fatal myocardial infarction or death.

Main Results:

  • Overall 5-year survival in the matched cohort was low at 25.3%.
  • IMA use was associated with a significantly lower risk of death (adjusted HR 0.88) and the composite outcome (adjusted HR 0.89) compared to SVG.
  • These findings were consistent across subgroups based on sex, age, race, and comorbidities.

Conclusions:

  • Despite low overall survival rates, IMA grafting demonstrates a reduced risk of mortality and cardiovascular morbidity compared to SVG in dialysis patients.
  • The findings support the use of IMA for coronary artery bypass grafting in patients with ESRD on maintenance dialysis.
Abstract

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