CABG Safer than PCI for Hemodialysis Patients

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Coronary artery bypass grafting (CABG) may be a better option than percutaneous coronary intervention (PCI) for patients with end-stage renal disease (ESRD) requiring coronary revascularization, according to a new study.

Using the U.S. Renal Data System database, Tara I. Chang, MD, of Stanford University in Palo Alto, Calif., and colleagues identified 21,981 patients on maintenance hemodialysis who received initial coronary revascularization with either CABG or PCI. The median follow-up times for the CABG and PCI groups were 1.9 years and 1.4 years, respectively.

The cohort had unadjusted five-year survival rates of 22%-25% regardless of revascularization strategy, according to the investigators. After adjusting for multiple variables, CABG was associated with a significant 13% decreased risk of death and a 12% decreased risk of a composite of death or myocardial infarction, Dr. Chang's group reported in the Journal of the American Society of Nephrology (2012;23:2042-2049).

“In light of the absence of any randomized trials or recent nationally representative observational studies, these results help inform patients with ESRD and their physicians about the clinical outcomes after coronary revascularization in this high-risk population,” the authors wrote.

In addition, Dr. Chang's team noted that their study “helps to fill an important gap in the currently available evidence regarding CABG compared with PCI in patients with ESRD on dialysis.”

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