Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention

Sugumar, Hariharan; Lancefield, T.; Andrianopoulos, Nick; Duffy, Stephen J.; Ajani, A.; Freeman, Melanie; Buxton, Brian F.; Brennan, A.; Yan, Bryan P.; Dinh, D.; Smith, Julian Anderson; Charter, Kerrie; Farouque, Omar; Reid, Christopher M.; Clark, David

doi:10.1016/j.ijcard.2014.01.096

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…While we are unaware of any published clinical trials specifically randomizing individuals with CKD to CABG versus PCI, several observational studies have suggested that CABG was associated with lower mortality than PCI in the setting of CKD 15, 44-46 , and at least one suggested that the mortality benefit increased as eGFR declined 15 . In contrast, a study by Szczech 47 was consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Charytan

Desai

Mathur

et al. 2016

Kidney International

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Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD and unbiased data comparing bypass surgery (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3-5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3-5 CKD of which 137 were stage 3b-5 CKD. Among individuals with stage 3-5 CKD survival through 5-years was not different following CABG compared with PCI (hazard ratio 0.99, 95% confidence interval: 0.67, 1.46) or stage 3b-5 CKD (1.29: 0.68, 2.46). However, CKD modified the impact on survival free from myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (0.97: 0.80, 1.17), but was significantly lower following CABG in stage 3-5 CKD (0.49: 0.29, 0.82) and stage 3b-5 CKD (0.23: 0.09, 0.58). Repeat revascularization was reduced following CABG compared with PCI regardless of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4-5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without impacting survival in these patients.

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Section: Discussionmentioning

confidence: 99%

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Charytan

Desai

Mathur

et al. 2016

Kidney International

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“…In COURAGE and SYNTAX, approximately 14% and 16% of patients were reported to have CKD, respectively 7,10 . Moreover, multiple studies have shown an association between CKD and increased rates of procedural complications and adverse outcomes following revascularization, suggesting that the balance of risk versus benefit of revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) and compared to optimal medical therapy (OMT) remains to be defined 1,2,6,11,12 …”

Section: Introductionmentioning

confidence: 99%

“…7,10 Moreover, multiple studies have shown an association between CKD and increased rates of procedural complications and adverse outcomes following revascularization, suggesting that the balance of risk versus benefit of revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) and compared to optimal medical therapy (OMT) remains to be defined. 1,2,6,11,12 Temporal trends in clinical outcomes following PCI suggest that evolution in devices, operator techniques, and medical therapy have led to modest improvement in safety, even in high-risk populations. 8,9,[13][14][15][16] However, there are limited data describing outcomes post PCI in realworld CKD patients.…”

mentioning

confidence: 99%

Adverse impact of chronic kidney disease on clinical outcomes following percutaneous coronary intervention

Bloom

Dinh

Noaman

et al. 2020

Cathet Cardio Intervent

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Aims We aimed to assess the impact of the severity of chronic kidney disease (CKD) with long‐term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods We analyzed data on consecutive patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR) from January 2014 to December 2018. Patients were stratified into tertiles of renal function; estimated glomerular filtration (eGFR) ≥60, 30–59 and < 30 ml/min/1.73 m2 (including dialysis). The primary outcome was long‐term all‐cause mortality obtained from linkage with the Australian National Death Index (NDI). The secondary endpoint was a composite of 30 day major adverse cardiac and cerebrovascular events. Results We identified a total of 51,480 patients (eGFR ≥60, n = 40,534; eGFR 30–59, n = 9,521; eGFR <30, n = 1,425). Compared with patients whose eGFR was ≥60, those with eGFR 30–59 and eGFR<30 were on average older (77 and 78 vs. 63 years) and had a greater burden of cardiovascular risk factors. Worsening CKD severity was independently associated with greater adjusted risk of long‐term NDI mortality: eGFR<30 hazard ratio 4.21 (CI 3.7–4.8) and eGFR 30–59; 1.8 (CI 1.7–2.0), when compared to eGFR ≥60, all p < .001. Conclusion In this large, multicentre PCI registry, severity of CKD was associated with increased risk of all‐cause mortality underscoring the high‐risk nature of this patient cohort.

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“…По частоте других ос-ложнений, включая ОПН и необходимость применения почечной заместительной терапии, различий между груп-пами выявлено не было. Наиболее частым осложнением со стороны сердечно-сосудистой системы в обеих группах являлась фибрилляция предсердий (15,8 2-й группах соответственно; р=0,129). Периоперацион-ный ИМ развился у 2,2% пациентов с СД и у 2,6% пациен-тов без СД (р=0,763).…”

Section: результатыunclassified

“…После исследования FRREEDOM [5] для больных СД это по-ложение закреплено в Европейских рекомендациях [4]. Для больных с наличием умеренной и выраженной по-чечной дисфункции это также показано [15], и проведе-ние КШ у больных с многососудистым поражением ко-ронарных артерий относится к классу рекомендаций IIa [9]. Кроме того, эти два состояния могут обладать взаи-моотягощающим действием, поэтому комплексное ис-следование прогностического влияния данных факторов у больных ишемической болезнью сердца (ИБС) при КШ является актуальным.…”

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The filtration renal function and diabetes mellitus type 2 as predictors of postoperative complications after coronary artery bypass grafting

Сумин¹,

Bezdenezhnykh²,

Безденежных³

et al. 2015

Kardiol. serdechno-sosud. khir.

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Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention

Cited by 7 publications

References 51 publications

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Adverse impact of chronic kidney disease on clinical outcomes following percutaneous coronary intervention

The filtration renal function and diabetes mellitus type 2 as predictors of postoperative complications after coronary artery bypass grafting

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