Myocardial Revascularization in Patients With 3 Vessel Coronary Artery Disease and Chronic Kidney Disease: Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention

被引：0
作者：
Fialka, Nicholas [1 ]
EL-Andari, Ryaan [1 ,3 ]
Kang, Jimmy [1 ]
Hong, Yongzhe [1 ]
Mcalister, Finlay A. [2 ]
Nagendran, Jayan [1 ]
Nagendran, Jeevan [1 ]
机构：
[1] Univ Alberta, Dept Surg, Div Cardiac Surg, Edmonton, AB, Canada
[2] Univ Alberta, Fac Med & Dent, Edmonton, AB, Canada
[3] Univ Alberta, Edmonton, AB, Canada
来源：
AMERICAN JOURNAL OF CARDIOLOGY | 2025年 / 243卷
关键词：
coronary artery bypass grafting; percutaneous coronary intervention; coronary artery disease; coronary revascularization; chronic kidney disease; DRUG-ELUTING STENTS; 5-YEAR FOLLOW-UP; POOLED ANALYSIS; SURGERY; OUTCOMES; SYNTAX; ASSOCIATION; IMPACT;
D O I：
10.1016/j.amjcard.2025.02.004
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Coronary artery disease (CAD) and chronic kidney disease (CKD) commonly co-exist. Superior outcomes with coronary artery bypass grafting(CABG) compared to percutaneous coronary intervention (PCI) have been identified in patients with 3 vessel CAD (TVD) and CKD but have been limited to mid-term follow-up. Herein, we analyzed the long-term outcomes of patients with TVD and CKD undergoing surgical versus percutaneous revascularization. 1,599 patients with CKD and TVD without STEMI or previous revascularization underwent coronary angiography between 2009 and 2018. The primary outcome was all-cause mortality. Secondary outcomes included rates of readmission for myocardial infarction (MI), stroke, repeat revascularization, and overall rehospitalization. 453 patients were included in the final analysis (PCI 373; CABG 80; median followup 9.3 years). All results are presented as CABG versus PCI. The rate of all-cause mortality at the longest follow-up (14.1 years) was significantly lower in patients who underwent CABG (68.9% vs 83.1%, p = 0.039, adjusted Hazard Ratio (aHR) 0.68, 95% confidence interval (CI) 0.47-0.98). Readmission rates for MI (10.2% vs. 28.4%, p = 0.009, aHR 0.37, 95% CI 0.17-0.77) and repeat revascularization (3.1% vs. 24.4%, p <0.001, aHR 0.09, 95% CI 0.02-0.34) were also lower after CABG than after PCI. No significant difference was observed in the rates of readmission for stroke or all causes. In conclusion, in this retrospective single-center study, we confirmed that the previously described advantages of CABG over PCI in patients with CKD and TVD persist with extended long-term follow-up. CABG should be considered the gold standard approach to revascularization in this patient population.<br /> (c) 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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页码：8 / 14
页数：7
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