PCI, CABG Both Acceptable for CKD Patients With LMCAD

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Patients with, without chronic kidney disease have less acute renal failure with PCI.
Patients with, without chronic kidney disease have less acute renal failure with PCI.

(HealthDay News) -- For patients with left main coronary artery disease (LMCAD), those with and without chronic kidney disease (CKD) undergoing revascularization have similar long-term outcomes with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), according to a study published in the Journal of the American College of Cardiology.

Gennaro Giustino, MD, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the comparative effectiveness of PCI vs CABG surgery in 1869 patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function.

The researchers found that 19.3% of patients had CKD. Compared to patients without CKD, those with CKD had higher 3-year rates of the primary end point (composite of death, myocardial infarction, or stroke [20.8 vs 13.5%; hazard ratio, 1.60]). Patients with CKD more commonly had acute renal failure (ARF) within 30 days compared to those without CKD (5.0 vs 0.8%); ARF was strongly linked to the 3-year risk of death, stroke, or MI (50.7 vs 14.4%; hazard ratio, 4.59). In patients with and without CKD, ARF occurred less commonly after revascularization with PCI vs CABG (hazard ratios, 0.28 and 0.20, respectively). Patients with and without CKD had no significant differences in the rates of the primary composite end point after PCI and CABG.

"Both PCI and CABG are thus acceptable revascularization approaches in selected high-risk patients with LMCAD and CKD," the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

References

Giustino G, Mehran R, Serruys PW, et al. Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease EXCEL Trial. J Am Coll Cardiol 72(7). DOI:10.1016/j.jacc.2018.05.057

O'Gara PT. PCI or CABG for LMCA Revascularization in Patients With CKD: The Jury Is Still Out. J Am Coll CardiolDOI:10.1016/j.jacc.2018.05.056

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