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Post-Coronary Artery Bypass Medications in Dialysis Patients: Do We Need to Change Strategies?
Yu-Ning Hu1, Chwan-Yau Luo1, Meng-Ta Tsai1
1Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Insights
Patients with end-stage renal disease (ESRD) undergoing coronary artery bypass grafting (CABG) who survive surgery have acceptable long-term survival. Post-CABG statin use is a key predictor of improved long-term outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is common in end-stage renal disease (ESRD) patients with severe coronary artery disease.
- ESRD patients face higher surgical risks and poorer long-term outcomes after CABG.
Purpose of the Study:
- To report outcomes of ESRD patients who survived CABG.
- To identify predictors of long-term survival in ESRD patients post-CABG.
Main Methods:
- Retrospective analysis of 93 ESRD patients who survived isolated CABG (2005-2016).
- Evaluation of long-term outcomes: all-cause mortality, major adverse cardiac events (MACE), and reintervention.
- Analysis of predictors for long-term outcomes.
Main Results:
- 10-year survival rates: 34.9% (mortality), 55.6% (MACE-free), 66.6% (reintervention-free).
- Postoperative statin use significantly improved long-term survival (p=0.009).
- Postoperative beta-blocker use showed a trend towards improved survival (p=0.013), but significance was lost after matching.
Conclusions:
- ESRD patients surviving CABG demonstrate acceptable long-term survival.
- Post-CABG statin therapy is a significant predictor of better long-term survival in ESRD patients.
Background:
Coronary artery bypass grafting (CABG) is frequently performed in patients with end-stage renal disease (ESRD) together with severe coronary artery disease, after which, patients with ESRD have higher surgical risk and poorer long-term outcomes. We report our experience in patients with ESRD who survived in CABG and identify predictors of long-term outcomes.
Methods:
We retrospectively investigated 93 consecutive patients with ESRD who survived to discharge after isolated CABG between January 2005 and December 2016 at our institution. Long-term outcomes, including all-cause mortality after discharge, readmission due to major adverse cardiac events, and reintervention, were evaluated. Predictors affecting long-term outcomes were also analyzed.
Results:
The rates of freedom from all-cause mortality after discharge in 1, 3, 5, and 10 years were 92.1, 81.3, 71.9, and 34.9%, respectively. The rates of freedom from readmission due to major adverse cardiac events in 1, 3, 5, and 10 years were 90.7, 79.1, 69.9, and 55.6%, respectively. The rates of freedom from reintervention in 1, 3, 5, and 10 years were 95.3, 86.5, 79.0, and 66.6%, respectively. Postoperative β-blocker and statin use significantly improved overall long-term survival (β-blocker, p = 0.013; statin, p = 0.009). After case-control matching, patients who received statins showed better long-term survival than those without statins. The comparison of long-term survival between patients with and without β-blockers showed no significant difference after matching.
Conclusions:
After CABG, dialysis patients who survived to discharge had acceptable long-term overall survival. Post-CABG statin use in dialysis patients is a predictor of better long-term survival.
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