An optimal strategy for coronary revascularization in patients with severe renal dysfunction

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Optimal revascularization strategy for patients with renal dysfunction is unclear.
• Coronary artery bypass grafting (CABG) may carry higher mortality risk than percutaneous coronary intervention (PCI).
• Limited data exists on outcomes of CABG vs. PCI in severe renal dysfunction.

Purpose of the Study:

• To compare clinical outcomes of CABG and PCI in patients with severe renal dysfunction not on chronic hemodialysis.
• To evaluate the impact of severe renal dysfunction on outcomes after coronary revascularization.

Main Methods:

• Analysis of 374 patients with multivessel disease and eGFR <30 ml/min/1.73 m² from the CREDO-Kyoto Registry.
• Exclusion of patients with acute myocardial infarction.
• Propensity score matching to select 77 pairs for analysis with a median follow-up of 2.5 years.

Main Results:

• No significant difference in in-hospital mortality between CABG and PCI groups.
• Similar rates of renal function deterioration and early introduction of hemodialysis.
• CABG demonstrated significantly higher freedom from major adverse cardiac and cerebrovascular events and target lesion revascularization.

Conclusions:

• Coronary artery bypass grafting (CABG) is the standard treatment for coronary artery disease in patients with severe renal dysfunction.
• Despite advancements in percutaneous coronary intervention (PCI), CABG offers superior long-term clinical outcomes in this high-risk population.