Background: Chronic Kidney Disease (CKD) is a risk factor for Coronary Artery Disease (CAD). No randomized trial conducted yet to determine what revascularization procedure is superior among CKD patients diagnosed with CAD. This study evaluated clinical outcomes after percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with CKD.
Methods: Patients with CKD Stage 3 to 5 who underwent PCI and CABG for coronary artery disease in Philippine Heart Center from 2010 to 2013 were identified. Patients with cardiogenic shock, acute ST elevation myocardial infarction, left main coronary artery involvement, previous PCI or CABG, concomitant valvular or congenital problem were excluded from the study. Outcomes were assessed up to an average of 3.5 years after revascularization. The primary outcome was mortality. Secondary outcomes were myocardial infarction (MI) and repeat revascularization.
Results: Among CKD patients who underwent CABG, there was an 8.77% mortality rate or 5 out of 57 patients died compared to 7.59% mortality rate (6 out of 79 patients) in the PCI group (p value 0.804) . For the secondary outcomes, repeat revascularization was noted in 6.33% (5 out of 79 patients) in the PCI group vs. 3.51% (2 out of 57 patients) in the CABG group (p value 0.469); myocardial infarction occurred in 5.06% (4 out of 79 patients) in the PCI group vs. 3.51% (2 out of 57 patients) in the CABG group (p value 0.665).
Conclusion: There was no significant difference in the choice of revascularization procedure for patients with CKD in terms of mortality, repeat revascularization, and myocardial infarction. But there is a trend observed regarding decrease incidence of repeat revascularization and myocardial infarction in the post CABG group.