Predialysis coronary revascularization and postdialysis mortality

Area of Science:

• Nephrology
• Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are revascularization strategies for coronary artery disease.
• Patients with chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD) face unique challenges with cardiovascular interventions.
• Optimal revascularization strategy for advanced CKD patients progressing to ESRD remains unclear.

Purpose of the Study:

• To compare the association of CABG versus PCI with all-cause mortality in US veterans with incident ESRD.
• To evaluate the long-term outcomes of revascularization strategies prior to dialysis initiation.

Main Methods:

• A contemporary national cohort of 971 US veterans with incident ESRD was analyzed.
• Patients who underwent CABG or PCI up to 5 years before dialysis initiation were included.
• Cox proportional hazards models were used to adjust for covariates and assess mortality risk.

Main Results:

• 582 patients underwent CABG and 389 underwent PCI; 84% were diabetics.
• Post-dialysis mortality rates were 229/1000 patient-years for CABG and 311/1000 patient-years for PCI.
• CABG was associated with a 34% lower risk of death post-dialysis initiation compared to PCI (aHR 0.66; 95% CI: 0.51-0.86).

Conclusions:

• Coronary artery bypass grafting in advanced CKD patients is linked to a lower risk of death after initiating dialysis.
• CABG appears to be a superior revascularization strategy compared to PCI for ESRD patients.
• Findings were consistent across various patient subgroups, reinforcing the benefit of CABG.