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Updated: Jan 2, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Surgical versus percutaneous multivessel coronary revascularization in patients with chronic kidney disease
Arman Kilic1,2, Ibrahim Sultan1,2, Thomas G Gleason1,2
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Insights
Coronary artery bypass grafting (CABG) significantly reduces major adverse cardiac and cerebrovascular events (MACCE) compared to percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (MVCAD) and chronic kidney disease.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Multivessel coronary artery disease (MVCAD) poses significant challenges, particularly in patients with chronic kidney disease (CKD).
- Optimal revascularization strategies for MVCAD in CKD patients remain a critical area of clinical decision-making.
- Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are established revascularization methods.
Purpose of the Study:
- To compare the contemporary outcomes of surgical versus percutaneous coronary revascularization in patients with MVCAD and CKD.
- To evaluate the efficacy and safety of CABG versus PCI in this high-risk patient population.
- To provide evidence-based insights for optimizing revascularization strategies in MVCAD patients with impaired renal function.
Main Methods:
- A retrospective study included 1853 patients with MVCAD and reduced glomerular filtration rate (<60 ml/min) undergoing CABG or PCI between 2010 and 2017.
- The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of death, stroke, myocardial infarction, or repeat revascularization.
- Multivariable Cox regression and propensity matching were employed for risk adjustment and analysis.
Main Results:
- Coronary artery bypass grafting (CABG) was associated with significantly greater 5-year freedom from MACCE compared to percutaneous coronary intervention (PCI) (70.1% vs 47.3%, P < 0.0001), persisting after risk adjustment.
- Propensity-matched analysis of 704 patients confirmed CABG's superiority, showing greater 5-year freedom from MACCE (72.8% vs 45.8%, P < 0.0001) and improved 5-year survival (73.9% vs 52.3%, P < 0.0001).
- CABG also demonstrated lower rates of early and late mortality, readmission, myocardial infarction, and repeat revascularization compared to PCI.
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with a lower MACCE rate than percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease and chronic kidney disease.
- The findings underscore the importance of multidisciplinary discussions for determining the optimal revascularization strategy in MVCAD, especially in complex cases like those involving CKD.
- CABG appears to be the preferred revascularization strategy for MVCAD patients with chronic kidney disease, offering superior long-term outcomes.
Objectives:
This study compared contemporary outcomes following surgical versus percutaneous coronary revascularization for multivessel coronary artery disease (MVCAD) in patients with chronic kidney disease.
Methods:
Patients with MVCAD and a reduced glomerular filtration rate (<60 ml/min) undergoing coronary bypass surgery (CABG) or percutaneous coronary intervention (PCI) at a single institution between 2010 and 2017 were included. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite outcome of death, stroke, myocardial infarction or repeat revascularization. Multivariable Cox regression models were used for risk-adjustment and propensity matching was also performed.
Results:
A total of 1853 patients were included in the study (1269 CABG, 584 PCI). CABG was associated with greater 5-year freedom from MACCE (70.1% vs 47.3%, P < 0.0001), a finding that persisted after risk-adjustment. The rates of early and late mortality and readmission were also lower with CABG as were individual rates of myocardial infarction and repeat revascularization. A propensity-matched analysis generated 704 well-matched patients (352 in each arm) with similar results, including greater 5-year freedom from MACCE (72.8% vs 45.8%, P < 0.0001), improved 5-year survival (73.9% vs 52.3%, P < 0.0001), lower readmission (cause-specific hazard ratio 0.68, 95% confidence interval 0.58-0.80; P < 0.0001), lower individual rates of myocardial infarction (2.6% vs 9.7%, P < 0.0001) and repeat revascularization (1.1% vs 7.4%, P < 0.0001).
Conclusions:
CABG is associated with a lower MACCE rate than that of PCI in patients with MVCAD and chronic kidney disease. Multidisciplinary discussions regarding the optimal revascularization strategy are important in MVCAD, particularly in more complex scenarios such as chronic kidney disease.
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