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Article: Revascularization in patients with multivessel coronary artery disease and chronic kidney disease everolimus-eluting stents versus coronary artery bypass graft surgery

TitleRevascularization in patients with multivessel coronary artery disease and chronic kidney disease everolimus-eluting stents versus coronary artery bypass graft surgery
Authors
Keywordspercutaneous coronary intervention
multivessel disease
chronic kidney disease
Issue Date2015
Citation
Journal of the American College of Cardiology, 2015, v. 66, n. 11, p. 1209-1220 How to Cite?
Abstract© 2015 American College of Cardiology Foundation. Background Randomized trials of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) routinely exclude patients with chronic kidney disease (CKD). Objectives This study evaluated outcomes of PCI versus CABG in patients with CKD. Methods Patients with CKD who underwent PCI using everolimus-eluting stents were propensity-score matched to patients who underwent isolated CABG for multivessel coronary disease in New York. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Results Of 11,305 patients with CKD, 5,920 patients were propensity-score matched. In the short term, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.35 to 0.87), stroke (HR: 0.22; 95% CI: 0.12 to 0.42), and repeat revascularization (HR: 0.48; 95% CI: 0.23 to 0.98) compared with CABG. In the longer term, PCI was associated with a similar risk of death (HR: 1.07; 95% CI: 0.92 to 1.24), higher risk of MI (HR: 1.76; 95% CI: 1.40 to 2.23), a lower risk of stroke (HR: 0.56; 95% CI: 0.41 to 0.76), and a higher risk of repeat revascularization (HR: 2.42; 95% CI: 2.05 to 2.85). In the subgroup with complete revascularization with PCI, the increased risk of MI was no longer statistically significant (HR: 1.18; 95% CI: 0.67 to 2.09). In the 243 matched pairs of patients with end-stage renal disease on hemodialysis, PCI was associated with significantly higher risk of death (HR: 2.02; 95% CI: 1.40 to 2.93) and repeat revascularization (HR: 2.44; 95% CI: 1.50 to 3.96) compared with CABG. Conclusions In patients with CKD, CABG is associated with higher short-term risk of death, stroke, and repeat revascularization, whereas PCI with everolimus-eluting stents is associated with a higher long-term risk of repeat revascularization and perhaps MI, with no long-term mortality difference. In the subgroup on dialysis, the results favored CABG over PCI.
Persistent Identifierhttp://hdl.handle.net/10722/219803
ISSN
2015 Impact Factor: 17.759
2015 SCImago Journal Rankings: 10.097
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorBangalore, Sripal-
dc.contributor.authorGuo, Yu-
dc.contributor.authorSamadashvili, Zaza-
dc.contributor.authorBlecker, Saul-
dc.contributor.authorXu, Jinfeng-
dc.contributor.authorHannan, Edward L.-
dc.date.accessioned2015-09-23T02:57:59Z-
dc.date.available2015-09-23T02:57:59Z-
dc.date.issued2015-
dc.identifier.citationJournal of the American College of Cardiology, 2015, v. 66, n. 11, p. 1209-1220-
dc.identifier.issn0735-1097-
dc.identifier.urihttp://hdl.handle.net/10722/219803-
dc.description.abstract© 2015 American College of Cardiology Foundation. Background Randomized trials of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) routinely exclude patients with chronic kidney disease (CKD). Objectives This study evaluated outcomes of PCI versus CABG in patients with CKD. Methods Patients with CKD who underwent PCI using everolimus-eluting stents were propensity-score matched to patients who underwent isolated CABG for multivessel coronary disease in New York. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Results Of 11,305 patients with CKD, 5,920 patients were propensity-score matched. In the short term, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.35 to 0.87), stroke (HR: 0.22; 95% CI: 0.12 to 0.42), and repeat revascularization (HR: 0.48; 95% CI: 0.23 to 0.98) compared with CABG. In the longer term, PCI was associated with a similar risk of death (HR: 1.07; 95% CI: 0.92 to 1.24), higher risk of MI (HR: 1.76; 95% CI: 1.40 to 2.23), a lower risk of stroke (HR: 0.56; 95% CI: 0.41 to 0.76), and a higher risk of repeat revascularization (HR: 2.42; 95% CI: 2.05 to 2.85). In the subgroup with complete revascularization with PCI, the increased risk of MI was no longer statistically significant (HR: 1.18; 95% CI: 0.67 to 2.09). In the 243 matched pairs of patients with end-stage renal disease on hemodialysis, PCI was associated with significantly higher risk of death (HR: 2.02; 95% CI: 1.40 to 2.93) and repeat revascularization (HR: 2.44; 95% CI: 1.50 to 3.96) compared with CABG. Conclusions In patients with CKD, CABG is associated with higher short-term risk of death, stroke, and repeat revascularization, whereas PCI with everolimus-eluting stents is associated with a higher long-term risk of repeat revascularization and perhaps MI, with no long-term mortality difference. In the subgroup on dialysis, the results favored CABG over PCI.-
dc.languageeng-
dc.relation.ispartofJournal of the American College of Cardiology-
dc.subjectpercutaneous coronary intervention-
dc.subjectmultivessel disease-
dc.subjectchronic kidney disease-
dc.titleRevascularization in patients with multivessel coronary artery disease and chronic kidney disease everolimus-eluting stents versus coronary artery bypass graft surgery-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jacc.2015.06.1334-
dc.identifier.pmid26361150-
dc.identifier.pmcidPMC4944845-
dc.identifier.scopuseid_2-s2.0-84941064453-
dc.identifier.hkuros260478-
dc.identifier.volume66-
dc.identifier.issue11-
dc.identifier.spage1209-
dc.identifier.epage1220-
dc.identifier.eissn1558-3597-
dc.identifier.isiWOS:000360820800001-

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