Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease
Ting-Chao Lin1,2, Tse-Min Lu3,4, Feng-Chyn Huang5
1Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital.
Insights
For patients with unprotected left main coronary artery disease and chronic kidney disease, coronary artery bypass grafting (CABG) showed better long-term outcomes than percutaneous coronary intervention (PCI). CABG reduced risks of myocardial infarction and repeat revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Unprotected left main coronary artery disease (ULMCAD) requires careful treatment selection.
- Optimal revascularization strategy for ULMCAD patients with chronic kidney disease (CKD) remains unclear.
- This study compares long-term outcomes of CABG versus PCI in this high-risk population.
Purpose of the Study:
- To compare the long-term efficacy and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
- To evaluate outcomes in patients with unprotected left main coronary artery disease (ULMCAD) and chronic kidney disease (CKD).
Main Methods:
- Retrospective matched-pair analysis of 185 patients (PCI: 84, CABG: 101) with ULMCAD and CKD from 2004-2010.
- Primary endpoints: all-cause death, myocardial infarction (MI), stroke, repeat revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE).
- Median follow-up of 3.5 years.
Main Results:
- No significant difference in 30-day mortality (PCI: 3.5% vs. CABG: 8.9%, P=0.14).
- Higher long-term risk of MACCE (67% vs. 55%, P=0.048), MI (15.5% vs. 6.9%, P=0.024), and repeat revascularization (30.9% vs. 7.9%, P<0.001) in the PCI group.
- No significant differences in long-term death, stroke, or renal function impact.
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with significantly lower long-term risks of myocardial infarction and repeat revascularization.
- CABG may be a preferred revascularization strategy for patients with unprotected left main coronary artery disease and chronic kidney disease.
- Further research is needed to confirm these findings and guide clinical decision-making.
Abstract:
Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI.From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE).The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function.CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...