Coronary artery bypass surgery versus percutaneous coronary intervention for left main coronary artery disease with chronic kidney disease

Ting Chao Lin, Tse Min Lu, Feng Chyn Huang, Pai Feng Hsu, Chun Che Shih, Shing Jong Lin, Chiao Po Hsu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI. From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE). The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function. CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

Original languageEnglish
Pages (from-to)279-285
Number of pages7
JournalInternational Heart Journal
Volume59
Issue number2
DOIs
Publication statusPublished - Jan 1 2018
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Chronic Renal Insufficiency
Coronary Artery Bypass
Coronary Artery Disease
Myocardial Infarction
Cause of Death
Stroke
Coronary Stenosis
Patient Selection
Therapeutics
Kidney
Mortality
Population

Keywords

  • Coronary artery bypass grafting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary artery bypass surgery versus percutaneous coronary intervention for left main coronary artery disease with chronic kidney disease. / Lin, Ting Chao; Lu, Tse Min; Huang, Feng Chyn; Hsu, Pai Feng; Shih, Chun Che; Lin, Shing Jong; Hsu, Chiao Po.

In: International Heart Journal, Vol. 59, No. 2, 01.01.2018, p. 279-285.

Research output: Contribution to journalArticle

@article{085de186e9014d839b24c10873946a74,
title = "Coronary artery bypass surgery versus percutaneous coronary intervention for left main coronary artery disease with chronic kidney disease",
abstract = "Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI. From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE). The mean age was 73.4 ± 10.3 years with male (84{\%}) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9{\%}, CABG group: 75.2{\%}). After treatment, the 30-day mortality was 3.5{\%} in PCI and 8.9{\%} in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67{\%} versus 55{\%}, P = 0.048), MI (15.5{\%} versus 6.9{\%}, P = 0.024), and repeat revascularization (30.9{\%} versus 7.9{\%}, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function. CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.",
keywords = "Coronary artery bypass grafting",
author = "Lin, {Ting Chao} and Lu, {Tse Min} and Huang, {Feng Chyn} and Hsu, {Pai Feng} and Shih, {Chun Che} and Lin, {Shing Jong} and Hsu, {Chiao Po}",
year = "2018",
month = "1",
day = "1",
doi = "10.1536/ihj.17-260",
language = "English",
volume = "59",
pages = "279--285",
journal = "International Heart Journal",
issn = "1349-2365",
publisher = "International Heart Journal Association",
number = "2",

}

TY - JOUR

T1 - Coronary artery bypass surgery versus percutaneous coronary intervention for left main coronary artery disease with chronic kidney disease

AU - Lin, Ting Chao

AU - Lu, Tse Min

AU - Huang, Feng Chyn

AU - Hsu, Pai Feng

AU - Shih, Chun Che

AU - Lin, Shing Jong

AU - Hsu, Chiao Po

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI. From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE). The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function. CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

AB - Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI. From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE). The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function. CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

KW - Coronary artery bypass grafting

UR - http://www.scopus.com/inward/record.url?scp=85044768812&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044768812&partnerID=8YFLogxK

U2 - 10.1536/ihj.17-260

DO - 10.1536/ihj.17-260

M3 - Article

C2 - 29563384

AN - SCOPUS:85044768812

VL - 59

SP - 279

EP - 285

JO - International Heart Journal

JF - International Heart Journal

SN - 1349-2365

IS - 2

ER -