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Percutaneous Coronary Intervention With a Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients

Szu-Yu Pan1,2, Ju-Yeh Yang3,4, Nai-Chi Teng5

  • 1Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.

Kidney Medicine
|February 2, 2024
PubMed

Insights

For patients on dialysis, drug-eluting stent percutaneous coronary intervention may offer better survival than coronary artery bypass grafting. This study compared revascularization strategies, finding PCI with DES associated with lower mortality risks.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Interventional Cardiology

Background:

  • Patients undergoing dialysis often have complex coronary artery disease (CAD).
  • Treatment decisions for CAD in dialysis patients involve balancing risks and benefits of revascularization strategies.
  • Comparative effectiveness data for percutaneous coronary intervention with drug-eluting stent (PCI-DES) versus coronary artery bypass grafting (CABG) in this population is limited.

Purpose of the Study:

  • To compare the effectiveness of PCI-DES versus CABG in patients receiving dialysis.
  • To evaluate the impact of revascularization strategy on mortality and repeat procedures in dialysis patients with CAD.

Main Methods:

  • Retrospective observational cohort study using the Taiwan National Health Insurance Research Database (2009-2015).
  • Identified patients on dialysis hospitalized for coronary revascularization.
  • Used propensity score matching to compare outcomes between PCI-DES and CABG groups.
  • Analyzed all-cause mortality, in-hospital mortality, and repeat revascularization using Cox proportional hazards and logistic regression models.

Main Results:

  • A total of 1,840 propensity score-matched patients were analyzed.
  • CABG was associated with higher in-hospital mortality (12.5% vs 3.3%) and longer hospital stays compared to PCI-DES.
  • After discharge, PCI-DES group had more frequent repeat revascularization, acute coronary syndrome, and hospitalizations.
  • At a median follow-up of 2.8 years, CABG was linked to a higher risk of all-cause mortality (aHR, 1.19; P = 0.006).

Conclusions:

  • PCI with drug-eluting stent may be associated with better long-term survival compared to CABG in patients receiving dialysis.
  • Findings suggest a potential shift in preferred revascularization strategy for this high-risk population.
  • Further prospective studies are warranted to confirm these findings and guide clinical practice.
Abstract

Keywords:
Coronary artery bypass graftingcoronary revascularizationdialysisdrug-eluting stentend-stage kidney diseasemortalitypercutaneous coronary interventionsurvival

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