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

ABSTRACT

Chronic kidney disease (CKD) might be an important determinant in choosing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). However, there is a scarcity of studies evaluating the effect of CKD on long-term outcomes after PCI relative to CABG in the population including severe CKD. Among 30257 consecutive patients patients who underwent first coronary revascularization with PCI or isolated CABG in the CREDO-Kyoto PCI/CABG registry Cohort-2 (n = 15330) and Cohort-3 (n = 14,927), we identified the current study population of 12,878 patients with multivessel or left main disease, and compared long-term clinical outcomes between PCI and CABG stratified by the subgroups based on the stages of CKD (no CKD eGFR >=60 ml/min/1.73m2, moderate CKD 60> eGFR >=30 ml/min/1.73m2, and severe CKD eGFR <30 ml/min/1.73m2 or dialysis). There were 6,999 patients without CKD (PCI n = 5,268, and CABG n = 1,731), 4,427 patients with moderate CKD (PCI n = 3,226, and CABG n = 1,201), and 1,452 patients with severe CKD (PCI n = 989, and CABG n = 463). During median 5.6 years of follow-up, the excess mortality risk of PCI relative to CABG was significant regardless of the stages of CKD without interaction (no CKD HR, 1.36; 95%CI, 1.12 to 1.65; p = 0.002, moderate CKD HR, 1.40; 95%CI, 1.17 to 1.67; p <0.001, and severe CKD HR, 1.33; 95%CI, 1.09 to 1.62; p = 0.004, Interaction p = 0.83). There were no significant interactions between CKD and the effect of PCI relative to CABG for all the outcome measures evaluated. In conclusion, PCI compared with CABG was associated with significantly higher risk for all-cause death regardless of the stages of CKD without any significant interaction.