Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft in Acute Coronary Syndrome patients with Renal
Xiaojia Zhang1, Liangping Hu2,3, Wen Zheng4
1Consulting Center of Biomedical Statistics, Academy of Military Medical Sciences, Beijing, 100850, China.
Insights
Percutaneous coronary intervention (PCI) offers short-term benefits over coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) patients with renal dysfunction. However, long-term outcomes show no significant difference, with risks equalizing over time.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with acute coronary syndrome (ACS) and renal dysfunction face poorer prognoses.
- Renal dysfunction significantly impacts cardiovascular outcomes and treatment strategies.
Purpose of the Study:
- To evaluate the time-dependent relative risk of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in ACS patients with renal dysfunction.
- To analyze revascularization strategies considering the influence of renal impairment.
Main Methods:
- Retrospective cohort study utilizing The Second Drug-Eluting Stent Impact on Revascularization Registry.
- Application of a time-dependent Cox model to assess the relative risk of major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- Short-term MACCE rates were lower following PCI compared to CABG.
- No significant difference in long-term MACCE rates was observed between PCI and CABG.
- Subgroup analyses confirmed similar findings across varying degrees of renal dysfunction.
- The hazard ratio for MACCE in PCI relative to CABG was found to be time-dependent, initially favoring PCI but increasing over time.
Conclusions:
- The choice of revascularization strategy (PCI vs. CABG) in ACS patients with renal dysfunction has a time-dependent impact on MACCE.
- While PCI shows an initial advantage, the long-term risk profile becomes comparable to CABG, necessitating careful consideration of the time horizon.
Abstract:
ACS patients with renal dysfunction tend to have a poorer prognosis than those with normal renal function. This retrospective cohort study was performed using The Second Drug-Eluting Stent Impact on Revascularization Registry, a retrospective registry, to evaluate the time-dependent relative risk of revascularization strategies in ACS patients with renal dysfunction. The study demonstrated that the short-term MACCE rate was lower after PCI than CABG. However, there was no significant difference in long-term MACCE rate. Subgroup analyses based on the degree of renal dysfunction resulted in similar findings. The revascularization strategy was identified as a time-dependent covariate by the time-dependent Cox model, and the regression coefficient was '-1.124 + 0.344 × ln (time + 1)'. For the entire object group and the separate subgroups, PCI was initially associated with a lower hazard for MACCE than CABG after revascularization, then the hazard ratio increases with time. In conclusion, the hazard ratio for MACCE in PCI relative to CABG is time-dependent. PCI tends to have a lower risk for MACCE than CABG in the short-term, then the hazard ratio increases with time.
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