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Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary

Amin Daoulah1, Rasha Taha Baqais2, Alwaleed Aljohar3

  • 1Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.

Kidney & Blood Pressure Research
|July 30, 2023
PubMed

Insights

Percutaneous coronary intervention (PCI) shows an in-hospital advantage over coronary artery bypass grafting (CABG) for left main coronary artery disease in patients with kidney issues. Long-term outcomes were similar for both PCI and CABG, regardless of renal function.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Nephrology

Background:

  • Optimal revascularization strategy for left main coronary artery (LMCA) disease in patients with impaired renal function remains unclear.
  • Limited evidence exists comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this specific patient population.

Purpose of the Study:

  • To compare the clinical outcomes of PCI versus CABG for LMCA disease treatment.
  • To evaluate outcomes in patients stratified by renal function status (impaired vs. normal).

Main Methods:

  • Retrospective cohort study of 2,138 patients from 14 centers (2015-2019).
  • Compared PCI vs. CABG in patients with impaired renal function (PCI: n=316, CABG: n=121).
  • Compared PCI vs. CABG in patients with normal renal function (PCI: n=906, CABG: n=795).
  • Primary outcomes: in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE).

Main Results:

  • In-hospital MACCE risk was significantly higher with CABG compared to PCI in both impaired (OR: 8.13) and normal renal function groups (OR: 2.59).
  • No significant difference in follow-up MACCE between PCI and CABG was observed in patients with impaired renal function (HR: 1.14).
  • Follow-up MACCE rates were also comparable between PCI and CABG in patients with normal renal function (HR: 1.12).

Conclusions:

  • PCI may offer an advantage over CABG regarding in-hospital MACCE for LMCA disease in patients with impaired renal function.
  • Long-term MACCE outcomes are comparable between PCI and CABG, irrespective of renal function status.
Abstract

Keywords:
Coronary artery bypass graftingGulfImpaired renal functionLeft main coronary arteryOutcomesPercutaneous coronary intervention

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