Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

Abstract

Background : Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD.Methods : The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed.Results : The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1 % vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046).Conclusions : The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…[1187][1188][1189][1190][1191][1192]1194 Five studies have suggested that survival is prolonged among patients with CKD after CABG compared with after PCI, 1187,1188,1191,1192,1194 whereas 3 other studies indicated that survival is similar after either of the 2 revascularization strategies, regardless of the severity of underlying renal disease. 1189 …”

“…Only one study identified by the writing committee used the Kidney Disease Outcome Quality Definition of renal disease grades: Stage 1, creatinine clearance of 90 to 120 mL/min; Stage 2, 60 to 89 mL/min; Stage 3, 30 to 59 mL/min; Stage 4, 15 to 29 mL/min; and Stage 5, Ͻ15 mL/min or ongoing dialysis (1186). Others studies simply described patients as receiving dialysis 1187,1188 or defined renal disease as any creatinine clearance Ͻ60 mL/min 1189,1190 or any serum creatinine above approximately 2.3 mg/dL. 1191,1192 Ongoing studies are beginning to use the AKIN (Acute Kidney Injury Network) or RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria and should ensure more consistency in the study of periprocedural complications of percutaneous revascularization.…”

Coronary revascularisation in patients with chronic kidney disease and end‐stage renal disease: A meta‐analysis

“…After removing the duplicates, 236 studies were screened and 58 studies were included in the second phase to assess their eligibility. As a result, 31 studies 11–41 met these requirements and were included in this analysis. The flow chart of the selection process is presented in Figure 1.…”

Patent Coronary Artery Bypass Graft (CABG) is not Sufficient for Myocardial Perfusion - Non-ST Elevation Myocardial Infarction Caused by Critical Subclavian Artery Stenosis

“…6 A lower incidence of major adverse cardiovascular events and repeat revascularizations has been reported in diabetic patients with multi-vessel disease who underwent coronary CABG compared with percutaneous coronary intervention. 7 Myocardial revascularization using the LITA has become the standard for CABG surgery due to its long-term graft patency and lower repeat revascularization rate compared to a saphenous vein graft. However, an occluded or stenosed CABG is a frequent cause of recurrent angina, particularly in patients with a heavy atherosclerotic burden, such as ESRD or poorly controlled diabetic mellitus.…”