Three-year clinical outcome of unprotected left main coronary artery disease patients complicated with chronic kidney disease treated by coronary artery bypass graft versus percutaneous coronary intervention

Background This study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) or after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in unprotected left main coronary artery disease (ULMCAD) patients complicated with chronic kidney disease (CKD). Methods Three hundred sixty-eight ULMCAD patients complicated with CKD who underwent first ever CABG (n = 207) or PCI with DES (n = 161) were recruited in this prospective cohort study. Patients were followed up to MACCE occurrence or 36 months after operations, and accumulating MACCE occurrence was calculated. Results Accumulating MACCE occurrence was decreased in CABG group compared with PCI group (P = 0.007). Subgroup analysis showed that CKD stage positively correlated with accumulating MACCE occurrence in total patients (P = 0.006) and in PCI-treated patients (P = 0.018), but not in CABG-treated patients (P = 0.217). Further univariate Cox's regression model displayed that CABG (versus (vs.) PCI) (P = 0.008) was associated with lower accumulating MACCE occurrence, while age (>= 65 years) (P = 0.048), hyperlipidemia (P = 0.013), diabetes (P = 0.012), previous heart failure (P = 0.011), previous stroke (P = 0.030), LVEF < 50% (P = 0.048), higher CKD stage (P = 0.002), and more diseased vessels (P = 0.022) were associated with increased accumulating MACCE occurrence. Forward stepwise multivariate Cox's regression model disclosed that CABG (vs. PCI) (P = 0.002) independently predicted decreased accumulating MACCE occurrence, whereas hyperlipidemia (P = 0.033), diabetes (P = 0.002), higher CKD stage (P = 0.001), and more diseased vessels (P = 0.009) independently predicted elevated accumulating MACCE occurrence. Conclusion CABG could be considered as the preferred treatment strategy compared with PCI with DES in ULMCAD patients complicated with CKD.