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Grazioli V, Di Mauro M, Perocchio G, Gerometta P, Agnino A, Pin M, Meani P, Matteucci M, Ronco D, Massimi G, Maessen J, Corradi D, Gaudino M, Lorusso R. Myocardial revascularization in patients with chronic kidney disease: a systematic review and meta-analysis of surgical versus percutaneous coronary revascularization. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf021. [PMID: 39969961 PMCID: PMC11897794 DOI: 10.1093/icvts/ivaf021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 02/15/2025] [Indexed: 02/20/2025]
Abstract
OBJECTIVES To compare outcomes of two different revascularization strategies in chronic kidney disease (CKD) patients: coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). METHODS We conducted this meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO (CRD42021238659), evaluated studies comparing CABG and PCI in patients with CAD and CKD (defined by KDIGO guidelines). Data were extracted from PubMed, EMBASE and Cochrane from 2000 to 2023. The primary end-point was long-term major adverse cardiovascular and cerebrovascular event rates, with secondary end-points including 30-day mortality, stroke, myocardial infarction (MI) and repeat revascularization. Statistical analyses included Kaplan-Meier estimations, Cox regression, and meta-regression to address heterogeneity. Publication bias was assessed via funnel plots. No funding was received, and the authors report no conflicts of interest. RESULTS We included 33 studies with 402 300 patients (eGFR <60 ml/min/1.73 m2). The cohort comprised 132 314 coronary artery bypass graft and 269 986 PCI patients. Over 3 years, coronary artery bypass group provided protection against major adverse cardiac and cerebrovascular events, MI, and repeat revascularization compared to PCI. However, PCI showed better short-term outcomes, including lower 30-day mortality. Coronary artery bypass group was linked to a higher stroke risk over the 3-year follow-up. CONCLUSIONS Revascularization strategies for CKD and coronary artery disease patients should balance PCI's short-term benefits with CABG's long-term advantages.
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Affiliation(s)
- Valentina Grazioli
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Department of Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Michele Di Mauro
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Giacomo Perocchio
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Alfonso Agnino
- Department of Cardiovascular Surgery, Division of Robotic and Minimally-Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Maurizio Pin
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Paolo Meani
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiac Surgery Unit, ASST Sette Laghi, Varese, Italy
| | - Daniele Ronco
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giulio Massimi
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiac Surgery Unit, Santa Maria Hospital, Terni, Italy
| | - Jos Maessen
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Domenico Corradi
- Department of Medicine and Surgery, Unit of Pathology, University of Parma, Parma, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Presbyterian Hospital, New York, NY, USA
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft in Acute Coronary Syndrome patients with Renal Dysfunction. Sci Rep 2018; 8:2283. [PMID: 29396517 PMCID: PMC5797096 DOI: 10.1038/s41598-018-20651-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/22/2018] [Indexed: 01/17/2023] Open
Abstract
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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Wang Y, Zhu S, Gao P, Zhang Q. Comparison of coronary artery bypass grafting and drug-eluting stents in patients with chronic kidney disease and multivessel disease: A meta-analysis. Eur J Intern Med 2017; 43:28-35. [PMID: 28400078 DOI: 10.1016/j.ejim.2017.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The optimal revascularization strategy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD) and multivessel disease (MVD) remains unclear. METHODS Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception until June 2016. Studies that evaluate the comparative benefits of DES versus CABG in CKD patients with multi-vessel disease were considered for inclusion. We pooled the odds ratios from individual studies and conducted heterogeneity, quality assessment and publication bias analyses. RESULTS A total of 11 studies with 29,246 patients were included (17,928 DES patients; 11,318 CABG). Compared with CABG, pooled analysis of studies showed DES had higher long-term all-cause mortality (OR, 1.22; p<0.00001), cardiac mortality (OR, 1.29; p<0.00001), myocardial infarction (OR, 1.89; p=0.02), repeat revascularization (OR, 3.47; p<0.00001) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p=0.002), but lower short-term all-cause mortality (OR, 0.33; p<0.00001) and cerebrovascular accident (OR, 0.64; p=0.0001). Subgroup analysis restricted to patients with end-stage renal disease (ESRD) yielded similar results, but no significant differences were found regarding CVA and MACCE. CONCLUSIONS CABG for patients with CKD and MVD had advantages over PCI-DES in long-term all-cause mortality, MI, repeat revascularization and MACCE, but the substantial disadvantage in short-term mortality and CVA. Future large randomized controlled trials are certainly needed to confirm these findings.
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Affiliation(s)
- Yushu Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China
| | - Sui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Peijuan Gao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China.
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Shen W, Aguilar R, Montero AR, Fernandez SJ, Taylor AJ, Wilcox CS, Lipkowitz MS, Umans JG. Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study. Am J Nephrol 2017; 45:217-225. [PMID: 28135709 DOI: 10.1159/000455906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. METHODS We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. RESULTS The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. CONCLUSIONS Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.
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Affiliation(s)
- Wen Shen
- Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC, USA
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Subbiah AK, Chhabra YK, Mahajan S. Cardiovascular disease in patients with chronic kidney disease: a neglected subgroup. HEART ASIA 2016; 8:56-61. [PMID: 27933104 DOI: 10.1136/heartasia-2016-010809] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/11/2023]
Abstract
The burden of non-communicable diseases has increased exponentially over the past decade and they account for majority of the health-related morbidity and mortality worldwide. In line with this, the prevalence of chronic kidney disease (CKD) has been increasing over the years. CKD progresses through stages and it is well known that patients are more likely to die than to progress to end-stage renal disease. The presence of multiple classical and novel risk factors predisposes this group of patients to premature cardiovascular mortality. Though being a common entity, prevention, diagnosis and treatment of cardiovascular diseases in CKD are mired with controversies. This is due to the fact that many of the well-established diagnostic modalities and treatment strategies have not been studied in detail in patients with CKD. Moreover, most of the studies have excluded patients with renal dysfunction though they are at a higher risk for adverse outcomes and require specific dose modifications. This has limited the evidence base for optimal decision making. In this review, we aim to cover the risk factors, diagnosis and effectiveness of interventional strategies in patients with CKD.
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Affiliation(s)
- Arun Kumar Subbiah
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
| | - Yogesh K Chhabra
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
| | - Sandeep Mahajan
- Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India
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Möckel M, Searle J, Baberg HT, Dirschedl P, Levenson B, Malzahn J, Mansky T, Günster C, Jeschke E. Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI-analysis of routine statutory health insurance data. Open Heart 2016; 3:e000464. [PMID: 27752331 PMCID: PMC5051505 DOI: 10.1136/openhrt-2016-000464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/23/2022] Open
Abstract
Objectives We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy. Design Retrospective analysis of routine statutory health insurance data between 2010 and 2012. Main outcome measures Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year. Secondary outcomes were repeat revascularisation at 30 days and 1 year and bleeding events within 7 days. Results The total number of cases was n=4123 (PCI; n=3417), median age was 71 (IQR 62–77), 30.4% were women. The adjusted OR for death within 30 days was 0.59 (95% CI 0.43 to 0.81) for patients undergoing PCI versus CABG. At 1 year, the adjusted OR for major adverse cardiac and cerebrovascular events (MACCE) was 1.58 (1.32 to 1.89) for PCI versus CABG and 1.47 (1.23 to 1.75) for all-cause death. In the subgroup of patients with acute myocardial infarction (AMI), adjusted all-cause mortality at 30 days did not differ significantly between both groups (OR 0.75 (0.47 to 1.20)), whereas in patients without AMI the OR for 30-day mortality was 0.44 (0.28 to 0.68) for PCI versus CABG. At 1 year, the adjusted OR for MACCE in patients with AMI was 1.40 (1.06 to 1.85) for PCI versus CABG and 1.47 (1.08 to 1.99) for mortality. Conclusions In this cohort of unselected patients with ESRD undergoing revascularisation, the 1-year outcome was better for CABG in patients with and without AMI. The 30-day mortality was higher in non-AMI patients with CABG reflecting an early hazard with surgery. In cases where the patient's characteristics and risk profile make it difficult to decide on a revascularisation strategy, CABG could be the preferred option.
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Affiliation(s)
- Martin Möckel
- Division of Emergency Medicine and Chest Pain Units, Department of Cardiology , Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Julia Searle
- Division of Emergency Medicine and Chest Pain Units, Department of Cardiology , Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Henning Thomas Baberg
- Department of Cardiology and Nephrology , Helios Klinikum, Berlin-Buch , Berlin , Germany
| | - Peter Dirschedl
- Medical Service of the Health Funds (MDK) Baden-Württemberg , Lahr , Germany
| | - Benny Levenson
- German Society of Cardiologists in Private Practise (BNK-Bundesverband niedergelassener Kardiologen) , München , Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds (AOK) , Berlin , Germany
| | - Thomas Mansky
- Faculty of Economics and Management, Division of Structural Development and Quality Management in Healthcare , Technische Universität Berlin , Berlin , Germany
| | - Christian Günster
- Research Institute of the Local Health Care Funds (WIdO) , Berlin , Germany
| | - Elke Jeschke
- Research Institute of the Local Health Care Funds (WIdO) , Berlin , Germany
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Bundhun PK, Bhurtu A, Chen MH. Impact of coronary artery bypass surgery and percutaneous coronary intervention on mortality in patients with chronic kidney disease and on dialysis: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4129. [PMID: 27399124 PMCID: PMC5058853 DOI: 10.1097/md.0000000000004129] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Controversies have been observed among previously published and recently published studies comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) and patients on chronic dialysis. This study aimed to show the impact of CABG and PCI on mortality in these patients.Electronic databases were searched for studies comparing CABG and PCI in patients with CKD. The primary outcome was all-cause death whereas the secondary endpoints included other adverse cardiovascular outcomes reported. Causes of death were also analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.Eighteen studies involving a total number of 69,456 patients (29,239 patients in the CABG group and 40,217 patients in the PCI group) were included in this meta-analysis. Short-term mortality insignificantly favored PCI with OR: 1.24, 95% CI: 0.93-1.65; P = 0.15. Mortality at 1 year was similar in both groups with OR: 0.99, 95% CI: 0.91-1.08; P = 0.86, whereas the long-term mortality significantly favored CABG in patients with CKD and in patients on chronic dialysis with OR: 0.81, 95% CI: 0.70-0.94; P = 0.007 and OR: 0.81, 95% CI: 0.69-0.96; P = 0.01, respectively.In patients with CKD, the impact of CABG on the short-term mortality was insignificantly higher compared to PCI whereas at 1 year, a similar impact was observed. However, the impact of PCI on mortality was significantly higher during a long-term follow-up period in patients with CKD and in patients on chronic dialysis. Nevertheless, due to a high level of heterogeneity observed among several subgroups analyzed, randomized trials are required to completely solve this issue.
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Affiliation(s)
| | | | - Meng-Hua Chen
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
- Correspondence: Meng-Hua Chen, Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530027, P.R. China (e-mail: )
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Lautamäki A, Kiviniemi T, Biancari F, Airaksinen J, Juvonen T, Gunn J. Outcome after coronary artery bypass grafting and percutaneous coronary intervention in patients with stage 3b-5 chronic kidney disease. Eur J Cardiothorac Surg 2015; 49:926-30. [PMID: 26142469 DOI: 10.1093/ejcts/ezv233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/03/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Patients with chronic kidney disease (CKD) are generally considered to be at an increased risk for cardiovascular events and cardiac mortality. The prognostic significance of severe renal impairment in patients undergoing coronary revascularization remains mainly unknown because these patients have been excluded from randomized clinical trials. The aim of the present study was to compare the outcome after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with an estimated glomerular filtration rate (eGFR) of <45 ml/min/m(2). METHODS This retrospective study includes 110 patients who underwent PCI and 148 patients who underwent isolated CABG between 2007 and 2010. All patients had stage 3b-5 CKD (eGFR <45 ml/min/m(2)). RESULTS The median follow-up time was 25 (interquartile range 30) months. At 30 days and 3 years, postoperative de novo dialysis was required in 3.4 and 16.2% of CABG patients and in 0 and 6.6% (P = 0.10) of PCI patients. PCI was associated with similar mortality at 30 days (PCI 10.0% and CABG 12.2%, P = 0.068). At 3 years, PCI was associated with a significantly higher risk of mortality (50.4 vs 32.9, adjusted analysis: HR 1.77, 95% CI 1.13-2.77), repeat revascularization (20.3 vs 0.8%, too few for adjusted analysis) and major adverse cardiac and cerebrovascular events (57.8 vs 34.3%, HR 2.19, 95% CI 1.41-3.40). These findings were supported by propensity score-matched analysis. CONCLUSION Patients with moderate to severe CKD have a high rate of mortality and morbidity after either PCI or CABG. The fear of postoperative dialysis rates after CABG appears overemphasized since less than 5% of patients needed dialysis in the early postoperative period. This study provides evidence that this high-risk subset of patients should also be revascularized according to general recommendations. When feasible, CABG could be associated with better survival and freedom from cardiovascular events than PCI.
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Affiliation(s)
- Anna Lautamäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tatu Juvonen
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Khoso AA, Kazmi KA, Tahir S, Sharif H, Awan S. Mode of Coronary Revascularization and Short term Clinical Outcomes in Patients with Chronic Kidney Disease. Pak J Med Sci 2015; 30:1180-5. [PMID: 25674104 PMCID: PMC4320696 DOI: 10.12669/pjms.306.5540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Objective: Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients. Methods: In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction (MI), or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes. Results: Out of 159 patients with CKD, 85 (53.5%) received PCI and 74 (46.5%) received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD. Conclusion: Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD.
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Affiliation(s)
- Ashique Ali Khoso
- Ashique Ali Khoso, Senior Instructor, Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Khawar Abbas Kazmi
- Khawar Abbas Kazmi, Professor and Section Head of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Saqiba Tahir
- Saqiba Tahir, Medical Student, Aga Khan University, Karachi, Pakistan
| | - Hasanat Sharif
- Hasanat Sharif, Associate Professor and Section Head of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan.Department of Surgery, Aga Khan University Hospital
| | - Safia Awan
- Safia Awan, Statistician, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Roberts JK, McCullough PA. The management of acute coronary syndromes in patients with chronic kidney disease. Adv Chronic Kidney Dis 2014; 21:472-9. [PMID: 25443572 DOI: 10.1053/j.ackd.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/11/2022]
Abstract
Coronary heart disease is highly prevalent in patients with CKD, and survival after acute coronary syndrome (ACS) is worse compared with the general population. Many trials that define guidelines for cardiovascular disease excluded patients with kidney disease, leaving a gap between the evidence base and clinical reality. The underlying pathophysiology of vascular disease appears to be different in the setting of CKD. Patients with CKD are more likely to present with myocardial infarction and less likely to be diagnosed with ACS on admission compared with the general population. Patients with CKD appear to benefit with angiography and revascularization compared with medical management alone. However, the increased risk of in-hospital bleeding and risk of contrast-induced acute kidney injury are 2 factors that can limit overall benefit for some. Thus, judicious application of available therapies for the management of ACS is warranted to extend survival and reduce hospitalizations in this high-risk population. In this review, we highlight the clinical challenges and potential solutions for managing ACS in patients with CKD.
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