Acute renal failure (ARF) occurs less frequently with percutaneous coronary intervention than coronary artery bypass grafting among patients with chronic kidney disease (CKD), according to a new study.
The procedures do not differ significantly, however, in terms of the 3-year risk of a composite outcome of death, myocardial infarction (MI), or stroke.
The findings are from the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial in which investigators randomly assigned 1869 patients to undergo either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). CKD, defined as an estimated glomerular filtration rate below 60 mL/min/1.73 m2 using the CKD Epidemiology Collaboration equation, was present in 361 (19.3%) of these patients. The primary endpoint was a composite of death, myocardial infarction, or stroke at 3 years.
ARF within 30 days occurred significantly more frequently in patients with than without CKD (5% vs 0.8%), Gennaro Giustino, MD, of The Zena and Michael A. Wiener Cardiovascular Institute of the Icahn School of Medicine at Mount Sinai in New York, and colleagues reported in the Journal of the American College of Cardiology (2018;72:754-765).
Patients with CKD had higher 3-year rates of the composite endpoint than those without CKD (20.8% vs 13.5%). CKD was associated with a significant 60% increased risk of the primary endpoint.
ARF was associated with a significant 4.6-fold increased risk of the primary endpoint. In patients with and without CKD, ARF occurred significantly less frequently with PCI vs CABG (2.3% vs 7.7% and 0.3% vs 1.3%, respectively), according to the investigators. In the CKD and no-CKD groups, PCI was associated with a significant 72% and 80% decreased risk of ARF, respectively.
In patients with and without CKD, the investigators found no significant differences in the rates of the primary endpoint between PCI and CABG (23.4% vs 18.1% in the CKD group and 13.4% vs 13.5% in the no CKD group, respectively).
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. 2018;72:754-765.