The Impact of Renal Insufficiency on 2-Year Outcomes Following Pci or Cabg in the Syntax Trial

Holmes, David R.; Mohr, Friedrich W.; Serruys, Patrick W.; Vermeersch, Paul; Cauwelaert, P Van; Virtanen, Kari; Harjula, Ari; Leadley, Katrin; Dawkins, Keith D.

doi:10.1016/s0735-1097(10)61725-1

Cited by 3 publications

(2 citation statements)

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“…In this small subgroup of patients, CABG was superior to PCI for reduction of cardiovascular events (15.6% vs. 27.4%; P<0.05) driven by a reduction in repeat revascularization (5.0% vs. 14.9%; P<0.05) with no difference in death (9.9% vs. 11.8%). (26) When compared with the first generation DES used in SYNTAX, the second generation DES (such as EES) has thinner struts and thinner and more biocompatible polymer-properties which reduce inflammation, promote faster vessel healing and reduce the risk of restenosis and stent thrombosis. As such data from an all-comers population from randomized controlled trials,(27) observational registries(28) and meta-analyses of randomized trials(27,29) indicate reduction in death, MI and stent thrombosis with newer generation stents when compared with older generation stents.…”

Section: Discussionmentioning

confidence: 99%

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Bangalore

Guo

Samadashvili

et al. 2015

Journal of the American College of Cardiology

122

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Background Randomized trials of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery have routinely excluded patients with chronic kidney disease (CKD). Objectives To evaluate the outcomes with PCI vs. CABG in patients with CKD. Methods Patients with CKD (eGFR <60mL/min/1.73m2) who underwent PCI using everolimus eluting stents (EES) were propensity score matched to patients who underwent isolated CABG surgery for multivessel coronary disease in New York State. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction(MI), stroke and repeat revascularization. Results Among 11,305 patients with CKD, 5,920 patients (2,960 pairs) were propensity score matched. At short-term (within 30 days), PCI was associated with a lower risk of death [HR=0.55; 95% CI=0.35-0.87], stroke [HR=0.22; 95% CI=0.12-0.42] and repeat revascularization [HR=0.48; 95%CI=0.23-0.98] when compared with CABG. At longer-term (mean 2.9 years), PCI was associated with a similar risk of death [HR=1.07; 95% CI=0.92-1.24], higher risk of myocardial infarction [HR=1.76; 95% CI=1.40-2.23], a lower risk of stroke [HR=0.56; 95% CI=0.41-0.76] and higher risk of repeat revascularization [HR=2.42; 95% CI=2.05-2.85]. In the subgroup of patients who underwent who underwent complete revascularization with PCI, the increased risk of myocardial infarction was no longer statistically significant [HR=1.18, 95% CI=0.67-2.09]. In the 243 pairs of patients with end stage renal disease on hemodialysis, PCI was associated with a significant higher risk of death [HR=2.02; 95% CI=1.40-2.93] and repeat revascularization [HR=2.44; 95% CI=1.50-3.96] when compared with CABG. Conclusions In subjects with CKD, CABG is associated with higher short-term risk of death, stroke and repeat revascularization whereas PCI with EES is associated with higher long-term risk of repeat revascularization and perhaps MI (in those with incomplete revascularization), with no mortality difference between CABG and PCI long-term. However, in the subgroup on dialysis, the results favored CABG over PCI.

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Section: Discussionmentioning

confidence: 99%

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Bangalore

Guo

Samadashvili

et al. 2015

Journal of the American College of Cardiology

122

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“…Additionally, subgroup analyses also yielded similar results. The SYNTAX trial demonstrated that, in patients with renal dysfunction, CABG was superior to PCI for a lower incidence of MACCE (15.6% vs. 27.4%, P < 0.05) 27 . Aoki J. et al .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft in Acute Coronary Syndrome patients with Renal Dysfunction

Xiao-jia

Wen

2018

Sci Rep

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ACS patients with renal dysfunction tend to have a poorer prognosis than those with normal renal function. This retrospective cohort study was performed using The Second Drug-Eluting Stent Impact on Revascularization Registry, a retrospective registry, to evaluate the time-dependent relative risk of revascularization strategies in ACS patients with renal dysfunction. The study demonstrated that the short-term MACCE rate was lower after PCI than CABG. However, there was no significant difference in long-term MACCE rate. Subgroup analyses based on the degree of renal dysfunction resulted in similar findings. The revascularization strategy was identified as a time-dependent covariate by the time-dependent Cox model, and the regression coefficient was ‘−1.124 + 0.344 × ln (time + 1)’. For the entire object group and the separate subgroups, PCI was initially associated with a lower hazard for MACCE than CABG after revascularization, then the hazard ratio increases with time. In conclusion, the hazard ratio for MACCE in PCI relative to CABG is time-dependent. PCI tends to have a lower risk for MACCE than CABG in the short-term, then the hazard ratio increases with time.

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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

Sugumar

Lancefield

Andrianopoulos

et al. 2014

International Journal of Cardiology

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The Impact of Renal Insufficiency on 2-Year Outcomes Following Pci or Cabg in the Syntax Trial

Cited by 3 publications

References 0 publications

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft in Acute Coronary Syndrome patients with Renal Dysfunction

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

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