Risks of death and end-stage renal disease after surgical compared with percutaneous coronary revascularization in elderly patients with chronic kidney disease.
Risks of death and end-stage renal disease after surgical compared with percutaneous coronary revascularization in elderly patients with chronic kidney disease.
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DOI：
10.1161/circulationaha.111.083568
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发表时间：
2012-09-11
期刊：
影响因子：
37.8
通讯作者：
Herzog CA
中科院分区：
文献类型：
--
作者：
Charytan DM;Li S;Liu J;Herzog CA
Revascularization by coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is frequently deferred in patients with chronic kidney disease (CKD) to avoid precipitating end-stage renal disease (ESRD), but reliable estimates of absolute and relative risks of death and ESRD following CABG and PCI are unavailable. CKD patients undergoing CABG (n = 4547) or PCI (n = 8620) were identified and tracked using the 5% Medicare sample. The cumulative incidence of ESRD and death were reported for observed events. A Cox model with the Fine-Gray method was used to account for competing risks in assessing relative hazards of death and ESRD. Three-year cumulative incidence of ESRD was lower (CABG, 6.8%; PCI, 5.4%) than death (CABG, 28.3%; PCI, 32.8%). The adjusted hazard ratio of death was higher during the first 3 months after CABG than after PCI (1.25, 95% confidence interval 1.12-1.40, P < 0.001), but lower from 6 months on (0.61, 0.55-0.69). Conversely, risk of ESRD after CABG was higher during the first 3 months (1.59, 1.27-2.01, P < 0.001), but was not statistically significant from 3 months on. The adjusted hazard ratio of combined death or ESRD was similar to death. Among CKD patients undergoing coronary revascularization, death is more frequent than ESRD. The Incidence of ESRD was lower throughout follow-up after PCI, but long-term risks of death or combined death and ESRD were lower after CABG. Our data suggest better overall clinical outcomes with CABG than with PCI in CKD patients.
