Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

doi:10.1016/j.amjcard.2014.05.034

Cited by 54 publications

(59 citation statements)

References 17 publications

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“…The results in the dialysis cohort is consistent with data from the CREDO-Kyoto PCI/CABG registry analysis of 388 patients on dialysis where CABG was associated with lower risk of cardiac death, MI and repeat revascularization, compared with PCI using BMS or 1 st generation DES, although there was no difference in all-cause death between the two groups. (35) However, other studies comparing CABG with PCI using 1 st generation DES (N=104 patients) have shown a lower risk of both all-cause death and cardiac death with CABG in patients on hemodialysis (36). The results are also consistent with the analysis by Shroff et al, where short term mortality was higher after CABG but long-term survival was superior, but the Shroff study did not directly compare CABG vs. PCI and PCI was performed mainly using 1 st generation DES.…”

Section: Discussionmentioning

confidence: 99%

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Bangalore

Guo

Samadashvili

et al. 2015

Journal of the American College of Cardiology

120

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Background Randomized trials of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery have routinely excluded patients with chronic kidney disease (CKD). Objectives To evaluate the outcomes with PCI vs. CABG in patients with CKD. Methods Patients with CKD (eGFR <60mL/min/1.73m2) who underwent PCI using everolimus eluting stents (EES) were propensity score matched to patients who underwent isolated CABG surgery for multivessel coronary disease in New York State. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction(MI), stroke and repeat revascularization. Results Among 11,305 patients with CKD, 5,920 patients (2,960 pairs) were propensity score matched. At short-term (within 30 days), PCI was associated with a lower risk of death [HR=0.55; 95% CI=0.35-0.87], stroke [HR=0.22; 95% CI=0.12-0.42] and repeat revascularization [HR=0.48; 95%CI=0.23-0.98] when compared with CABG. At longer-term (mean 2.9 years), PCI was associated with a similar risk of death [HR=1.07; 95% CI=0.92-1.24], higher risk of myocardial infarction [HR=1.76; 95% CI=1.40-2.23], a lower risk of stroke [HR=0.56; 95% CI=0.41-0.76] and higher risk of repeat revascularization [HR=2.42; 95% CI=2.05-2.85]. In the subgroup of patients who underwent who underwent complete revascularization with PCI, the increased risk of myocardial infarction was no longer statistically significant [HR=1.18, 95% CI=0.67-2.09]. In the 243 pairs of patients with end stage renal disease on hemodialysis, PCI was associated with a significant higher risk of death [HR=2.02; 95% CI=1.40-2.93] and repeat revascularization [HR=2.44; 95% CI=1.50-3.96] when compared with CABG. Conclusions In subjects with CKD, CABG is associated with higher short-term risk of death, stroke and repeat revascularization whereas PCI with EES is associated with higher long-term risk of repeat revascularization and perhaps MI (in those with incomplete revascularization), with no mortality difference between CABG and PCI long-term. However, in the subgroup on dialysis, the results favored CABG over PCI.

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Section: Discussionmentioning

confidence: 99%

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Bangalore

Guo

Samadashvili

et al. 2015

Journal of the American College of Cardiology

120

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“…11,12 When CABG and PCI were compared in CKD, observational studies reported conflicting results. While some observational studies reported long-term CABG mortality benefit over PCI despite a higher early risk of death and ESRD, other studies suggested comparable outcomes.…”

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confidence: 99%

“…However, the risk of all-cause death was not different. 12,16,17 Physicians are overcoming challenges based on individual cases. The current challenge is to study the CAD patient with CKD in prospective randomized trials to provide an evidence-based approach to therapy.…”

mentioning

confidence: 99%

Is kidney function affecting the management of myocardial infarction? A retrospective cohort study in patients with normal kidney function, chronic kidney disease stage III–V, and ESRD

Saad¹,

Karam²,

Faddoul³

et al. 2016

IJNRD

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Patients with chronic kidney disease (CKD) are three times more likely to have myocardial infarction (MI) and suffer from increased morbidity and higher mortality. Traditional and unique risk factors are prevalent and constitute challenges for the standard of care. However, CKD patients have been largely excluded from clinical trials and little evidence is available to guide evidence-based treatment of coronary artery disease in patients with CKD. Our objective was to assess whether a difference exists in the management of MI (ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction) among patients with normal kidney function, CKD stage III–V, and end-stage renal disease (ESRD) patients. We conducted a retrospective cohort study on patients admitted to Staten Island University Hospital for the diagnosis of MI between January 2005 and December 2012. Patients were assigned to one of three groups according to their kidney function: Data collected on the medical management and the use of statins, platelet inhibitors, beta-blockers, and angiotensin converting enzyme inhibitors/angiotensin receptor blockers were compared among the three cohorts, as well as medical interventions including: catheterization and coronary artery bypass graft (CABG) when indicated. Chi-square test was used to compare the proportions between nominal variables. Binary logistic analysis was used in order to determine associations between treatment modalities and comorbidities, and to account for possible confounding factors. Three hundred and thirty-four patients (mean age 67.2±13.9 years) were included. In terms of management, medical treatment was not different among the three groups. However, cardiac catheterization was performed less in ESRD when compared with no CKD and CKD stage III–V (45.6% vs 74% and 93.9%) ( P <0.001). CABG was performed in comparable proportions in the three groups and CABG was not associated with the degree of CKD ( P =0.078) in binary logistics regression. Cardiac catheterization on the other hand carried the strongest association among all studied variables ( P <0.001). This association was maintained after adjusting for other comorbidities. The length of stay for the three cohorts (non-CKD, CKD stage III–V, and ESRD on hemodialysis) was 16, 17, and 15 days, respectively and was not statistically different. Many observations have reported discrimination of care for patients with CKD considered suboptimal candidates for aggressive management of their cardiac disease. In our study, medical therapy was achieved at high percentage and was comparable among groups of different kidney function. However, kidney disease seems to affect the management of patients with acute MI; percutaneous coronary angiography is not uniformly performed in patients with CKD and ESRD when compared with patients with normal kidney function.

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“…Although many of the included studies were completed prior to the adoption of modern practice patterns, a second meta-analysis, published in 2011 and including three more recent trials, yielded similar results [39]. Registry data in the United States (1997–2009) and the CREDO-Kyoto registry in Japan (2005–2007) have also confirmed the superiority of CABG to PCI for long-term clinical outcomes in dialysis patients, especially for multi-vessel procedures [40,41]. …”

Section: Acute Coronary Syndromes and Myocardial Revascularizationmentioning

confidence: 94%

Cardiovascular complications in chronic dialysis patients

Mavrakanas

Charytan²

2016

Current Opinion in Nephrology and Hypertension

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Structured abstract Purpose of review This review article focuses on the most significant cardiovascular complications in dialysis patients (sudden cardiac death, acute coronary syndromes, heart failure, and atrial fibrillation). Recent findings Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of sudden cardiac death. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death. A recently published matched cohort study in dialysis patients who received a defibrillator for primary prevention showed that there was no significant difference in mortality rates between defibrillator -treated patients and propensity matched controls. Two randomized controlled trials are currently recruiting participants and will hopefully answer the question whether implantable or wearable cardioverter-defibrillators can prevent sudden cardiac death. An observational study using USRDS data demonstrated how difficult it is to keep hemodialysis patients on warfarin, as more than two thirds discontinued the drug during the first year. The ISCHEMIA-CKD trial may provide answers about the optimal strategy for treatment of atherosclerotic coronary disease in patients with advanced CKD. Summary The article reviews diagnosis of acute coronary syndromes in dialysis patients, current literature on myocardial revascularization, and data on fatal and non-fatal cardiac arrhythmia. The new classification of heart failure in end-stage renal disease is reviewed. Finally, available cohort studies on warfarin for stroke prevention in dialysis patients with atrial fibrillation are reviewed.

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Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Cited by 54 publications

References 17 publications

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Is kidney function affecting the management of myocardial infarction? A retrospective cohort study in patients with normal kidney function, chronic kidney disease stage III–V, and ESRD

Cardiovascular complications in chronic dialysis patients

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Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Cited by 54 publications

References 17 publications

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease

Is kidney function affecting the management of myocardial infarction? A retrospective cohort study in patients with normal kidney function, chronic kidney disease stage III&ndash;V, and ESRD

Cardiovascular complications in chronic dialysis patients

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Is kidney function affecting the management of myocardial infarction? A retrospective cohort study in patients with normal kidney function, chronic kidney disease stage III–V, and ESRD