Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Versus Without Chronic Kidney Disease

Yamamoto, Ko; Natsuaki, Masahiro; Morimoto, Takeshi; Shiomi, Hiroki; Takeji, Yasuaki; Kadota, Kazushige; Imada, Kazuaki; Toyofuku, Mamoru; Kanemitsu, Naoki; Shinoda, Eiji; Suwa, Satoru; Iwakura, Atsushi; Tamura, Toshihiro; Soga, Yoshiharu; Inada, Tsukasa; Matsuda, Mitsuo; Koyama, Tadaaki; Aoyama, Takeshi; Kato, Eri; Sato, Yukihito; Furukawa, Yutaka; Ando, Kenji; Yamazaki, Fumio; Komiya, Tatsuhiko; Minatoya, Kenji; Nakagawa, Yoshihisa; Kimura, Takeshi

doi:10.1016/j.amjcard.2020.12.079

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Numerous studies have reported a positive correlation of cerebrovascular complications with CKD severity; moreover, CABG involves a higher rate of cerebral complications than PCI [ 23 , 24 ]. Our findings of a low rate of cerebral infarction could be attributed to the effect of OPCAB, which has been previously reported [ 25 ]. Additionally, the rate of reexploration associated with bleeding was 0–1% in each group, which was favorable without significant among-group differences.…”

Section: Discussionsupporting

confidence: 86%

Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease: Chronic Kidney Disease Has an Independent Adverse Effect on the Long-Term Outcome of Coronary Artery Bypass Grafting

Endo

Yamamoto

Kajimoto

et al. 2022

BioMed Research International

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We examined short- and long-term outcomes of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and the effect of renal function on these outcomes. We included 2783 patients who underwent primary elective CABG at a single institution between 2002 and 2020 (age: 67.6 ± 10.2 years; male: 2281 male). They were stratified based on their preoperative estimated glomerular filtration rate and underwent off-pump CABG (completion rate, 98.1%); 57.6% cases used bilateral internal thoracic arteries (BITA). In-hospital mortality rate was 1.0%. Logistic regression analysis revealed that low left ventricular function (<40%), but not chronic kidney disease (CKD) severity, was an independent predictive risk factor for postoperative hospital mortality. Significant differences existed in respiratory complications, infections, and hospitalization duration according to CKD severity. Deep sternal wound infection rate was 0.5%. The mean follow-up period was 7.1 (0–18.5) years. Estimated 10-year survival rates were negatively correlated with CKD severity; in the Cox hazard model, severe CKD was an independent predictor of long-term survival. We examined the relationship between preoperative and intraoperative factors and their effects on long-term survival using propensity score matching by dividing the renal function severity into G1–2 and G3–5. Renal function severity, age, and operative time were independent risk factors. No prognostic improvement was observed with BITA grafts; graft patency was superior in the right internal thoracic artery (52/52; 100%) than in the great saphenous vein (48/59; 81.4%) in G5. Post-CABG in-hospital mortality was unrelated to renal function, but CKD severity strongly influenced long-term survival. Operation time was an important predictor of long-term prognosis in patients with impaired renal function. Treatment plans, including graft and anastomosis-site selections, should be designed to shorten the operation time. In conclusion, using the right internal thoracic artery in CABG is more beneficial in patients with CKD and cardiovascular comorbidities.

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Section: Discussionsupporting

confidence: 86%

Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease: Chronic Kidney Disease Has an Independent Adverse Effect on the Long-Term Outcome of Coronary Artery Bypass Grafting

Endo

Yamamoto

Kajimoto

et al. 2022

BioMed Research International

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“…Thus, registry analyses are the only source of information for these patients. In 2021, such reports demonstrated superiority of CABG over PCI in the presence of chronic kidney disease, 16 diabetes mellitus 17 and patients above 80 years of age. 18 Those studies reporting information on myocardial infarctions show again reduced rates of non-fatal myocardial infarction in the CABG groups.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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