Predialysis coronary revascularization and postdialysis mortality

Abduzhappar Gaipov, Miklos Z. Molnar, Praveen K. Potukuchi, Keiichi Sumida, Robert B. Canada, Oguz Akbilgic, Kairat Kabulbayev, Zoltan Szabo, Santhosh Koshy, Kamyar Kalantar-Zadeh, Csaba Kovesdy

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Abstract

Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 ± 8 years, 99% of patients were male, 79% were white, 19% were African American, and 84% had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95% confidence interval [CI], 205-256) and 311 per 1000 patient years (95% CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34% lower risk of death (multivariable adjusted hazard ratio, 0.66; 95% CI, 0.51-0.86, P =.002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.

Original languageEnglish (US)
Pages (from-to)976-983.e7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number3
DOIs
StatePublished - Mar 1 2019

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Mortality
Dialysis
Chronic Renal Insufficiency
Chronic Kidney Failure
Confidence Intervals
Veterans
Proportional Hazards Models
African Americans
Comorbidity
Coronary Vessels
Heart Failure
Myocardial Infarction
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Predialysis coronary revascularization and postdialysis mortality. / Gaipov, Abduzhappar; Molnar, Miklos Z.; Potukuchi, Praveen K.; Sumida, Keiichi; Canada, Robert B.; Akbilgic, Oguz; Kabulbayev, Kairat; Szabo, Zoltan; Koshy, Santhosh; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 3, 01.03.2019, p. 976-983.e7.

Research output: Contribution to journalArticle

Gaipov, A, Molnar, MZ, Potukuchi, PK, Sumida, K, Canada, RB, Akbilgic, O, Kabulbayev, K, Szabo, Z, Koshy, S, Kalantar-Zadeh, K & Kovesdy, C 2019, 'Predialysis coronary revascularization and postdialysis mortality', Journal of Thoracic and Cardiovascular Surgery, vol. 157, no. 3, pp. 976-983.e7. https://doi.org/10.1016/j.jtcvs.2018.08.107
Gaipov, Abduzhappar ; Molnar, Miklos Z. ; Potukuchi, Praveen K. ; Sumida, Keiichi ; Canada, Robert B. ; Akbilgic, Oguz ; Kabulbayev, Kairat ; Szabo, Zoltan ; Koshy, Santhosh ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Predialysis coronary revascularization and postdialysis mortality. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 3. pp. 976-983.e7.
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abstract = "Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 ± 8 years, 99{\%} of patients were male, 79{\%} were white, 19{\%} were African American, and 84{\%} had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95{\%} confidence interval [CI], 205-256) and 311 per 1000 patient years (95{\%} CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34{\%} lower risk of death (multivariable adjusted hazard ratio, 0.66; 95{\%} CI, 0.51-0.86, P =.002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.",
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T1 - Predialysis coronary revascularization and postdialysis mortality

AU - Gaipov, Abduzhappar

AU - Molnar, Miklos Z.

AU - Potukuchi, Praveen K.

AU - Sumida, Keiichi

AU - Canada, Robert B.

AU - Akbilgic, Oguz

AU - Kabulbayev, Kairat

AU - Szabo, Zoltan

AU - Koshy, Santhosh

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 ± 8 years, 99% of patients were male, 79% were white, 19% were African American, and 84% had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95% confidence interval [CI], 205-256) and 311 per 1000 patient years (95% CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34% lower risk of death (multivariable adjusted hazard ratio, 0.66; 95% CI, 0.51-0.86, P =.002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.

AB - Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 ± 8 years, 99% of patients were male, 79% were white, 19% were African American, and 84% had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95% confidence interval [CI], 205-256) and 311 per 1000 patient years (95% CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34% lower risk of death (multivariable adjusted hazard ratio, 0.66; 95% CI, 0.51-0.86, P =.002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.

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