Abstract: TH-OR006

Pre ESRD Coronary Artery Revascularization and Post ESRD Mortality

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Gaipov, Abduzhappar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Canada, Robert B., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Akbilgic, Oguz, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kabulbayev, Kairat, Kazakh national medical university, Almaty, Kazakhstan
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate CKD and ESRD. However, the optimal strategy for coronary artery revascularization in advanced CKD patients who transition to ESRD is unclear.

Methods

We examined a contemporary national cohort of 815 US veterans with incident ESRD, who underwent first CABG or PCI up to 5 years prior to dialysis initiation. We examined the association of CABG versus PCI with all-cause mortality following transition to dialysis, using Cox proportional hazards models adjusted for time to dialysis start, sociodemographics, comorbidities and medications.

Results

596 patients underwent CABG and 219 patients underwent PCI. The mean age was 66±8 years, 99% of patients were male, 78% were white, 20% were African Americans, and 84% were diabetic. The all-cause post-dialysis mortality rates after CABG and PCI were 301/1000 patient-years (PY) [95% CI=271–333] and 436/1000PY [95% CI=371–512], respectively. Mortality was lower after CABG (Figure). The multivariable adjusted hazard ratio of all-cause mortality in patients who underwent CABG compared to PCI was 0.72 (95% CI=0.58–0.89, p=0.003).

Conclusion

In patients with advanced CKD CABG is associated with lower risk of post-ESRD death compared to PCI.

Funding

  • NIDDK Support