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Management of coronary artery disease in patients on dialysis

Helen Pilmore1, Mark Webster2, Karishma Sidhu3

  • 1Department of Renal Medicine, University of Auckland, Auckland.

The New Zealand Medical Journal
|December 15, 2017
PubMed

Insights

For patients with end-stage renal failure (ESRF) and coronary artery disease, revascularization via coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) showed no survival benefit over medical management. Further randomized trials are needed for this high-risk group.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Outcomes Research

Background:

  • Coronary artery disease (CAD) is prevalent in end-stage renal failure (ESRF) patients.
  • Evidence supporting revascularization benefits in ESRF patients with CAD is limited.
  • Optimal management strategies for this high-risk population remain unclear.

Purpose of the Study:

  • To assess survival and cardiovascular outcomes in ESRF patients undergoing coronary angiography.
  • To compare outcomes of revascularization (CABG or PCI) versus medical management.
  • To evaluate treatment efficacy in ESRF patients with triple vessel disease.

Main Methods:

  • Retrospective analysis of ESRF patients undergoing coronary angiography (2003-2012).
  • Comparison of survival and major adverse cardiac events (MACE) between revascularization (CABG/PCI) and medical management groups.
  • Subgroup analysis for patients with triple vessel disease.

Main Results:

  • No significant difference in median survival was observed between CABG, PCI, and medical management groups (3.3, 2.9, and 2.9 years, respectively).
  • Survival outcomes did not differ significantly between treatment modalities, even in patients with triple vessel disease.
  • Incidence of major adverse cardiac events (MACE) was similar for revascularization and medical management.

Conclusions:

  • Revascularization (CABG or PCI) offers no apparent survival advantage over medical management in ESRF patients with coronary disease.
  • ESRF patients with coronary disease have a poor prognosis.
  • Randomized controlled trials are necessary to establish optimal management guidelines for this patient cohort.
Abstract

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