Coronary artery bypass grafting versus percutaneous coronary intervention in dialysis patients, 5-year follow-up

Abstract

Background: Cardiac disease is the most important cause of death in patients with end stage renal failure requiring dialysis. Although coronary revascularization in end stage renal disease patients has been studied extensively, the impact and efficacy of coronary treatment of dialysis patients remains controversial because of the high rate of mortality and stent restenosis. Many reports comparing CABG and PCI in the general population indicating a lower rate of cardiac events post CABG than PCI.
This study compares clinical outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in dialysis patients up to 5 years.

Methods: A retrospective study was performed in 109 dialysis patients who treated between 2005 and 2014 in Sheba Medical Center. 44 patients underwent CABG and 65 patients underwent PCI. The endpoint including second revascularization, nonfatal myocardial infraction or mortality.

Results: The preoperative characteristics of the patients were similar. The coronary disease was more complex in CABG group than in PCI group. The average number of coronary arteries involved was 2.7±1.0 in CABG group and 1.6±1.0 in PCI group.
The incidence of second revascularization was 5% in CABG group and 28% in PCI group, P-value

Conclusions: The patients who underwent CABG had a more complexed coronary disease.
CABG is superior for revascularization in dialysis patients compered with PCI.
In the long term the mortality rate was significantly lower in CABG group than in PCI group.