Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12080
Title: Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention.
Authors: Sugumar, Hariharan;Lancefield, Terase F;Andrianopoulos, Nick;Duffy, Stephen J;Ajani, Andrew E;Freeman, Melanie;Buxton, Brian F;Brennan, Angela L;Yan, Bryan P;Dinh, Diem T;Smith, Julian A;Charter, Kerrie;Farouque, Omar;Reid, Christopher M;Clark, David J
Institutional Author: Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) & Melbourne Interventional Group (MIG)
Affiliation: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; Department of Cardiology, Prince of Wales Hospital, Hong Kong, China.
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.
Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia. Electronic address: clarkdavidj@hotmail.com.
Issue Date: 24-Jan-2014
Citation: International Journal of Cardiology 2014; 172(2): 442-9
Abstract: Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD).8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 (n=1678:839), 30-59 mL/min/1.73 m2 (n=452:226) and <30 mL/min/1.73 m2 (n=74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI)<24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p=0.84, 12.8% vs. 17.3% p=0.12, and 23.0% vs. 40.5% p=0.05 in the three strata, respectively. In patients with eGFR≥60 mL/min/1.73 m2, long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p=0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m2, there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p=0.001). In patients with eGFR<30 mL/min/1.73 m2, there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p=0.17).Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.
Internal ID Number: 24521692
URI: http://ahro.austin.org.au/austinjspui/handle/1/12080
DOI: 10.1016/j.ijcard.2014.01.096
URL: http://www.ncbi.nlm.nih.gov/pubmed/24521692
Type: Journal Article
Subjects: Angioplasty
Coronary disease
Kidney
Revascularization
Surgery
Aged
Australia.epidemiology
Comorbidity
Coronary Artery Bypass.mortality
Coronary Disease.mortality.surgery
Female
Glomerular Filtration Rate
Humans
Kidney Diseases.mortality
Kidney Function Tests
Male
Middle Aged
New Zealand.epidemiology
Percutaneous Coronary Intervention.mortality
Registries
Appears in Collections:Journal articles

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