Coronary artery bypass grafting offers better long-term survival but an increased risk of early mortality compared with percutaneous coronary intervention among patients with end-stage renal disease (ESRD) and chronic kidney disease (CKD), new findings suggest.
The findings are from a systematic review and meta-analysis of 17 trials involving 33,584 ESRD patients and 6 studies involving 15,493 CKD patients. The study, led by Arun Kannan, MD, of the University of Arizona in Tucson, showed that coronary artery bypass grafting (CABG) significantly decreased the risk of late mortality by 14% and 18% in the ESRD and CKD groups, respectively, compared with percutaneous coronary intervention (PCI), according to an online report in the American Journal of Therapeutics. In addition, compared with PCI, CABG was associated with a significant 39% decreased risk of cardiovascular death in the ESRD population.
In the ESRD and CKD groups, CABG was associated with a 2.0 and 2.5 times increased risk of early mortality, respectively, compared with PCI. Furthermore, in the ESRD group, CABG patients had a significant 66% decreased risk of myocardial infarction compared with PCI patients. CABG was associated with a significant 88% and 73% decreased risk of repeat revascularization in ESRD and CKD patients, respectively.
The researchers defined early mortality as death occurring up to 30 days after coronary intervention.