Multi-vessel Disease Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease
Ahmed Mahmoud El Amrawy *
Cardiology Department, Faculty of Medicine, Alexandria University, Egypt and Department of Interventional Cardiology, Juan Ramon Jimenez University Hospitals, Spain.
Mahmoud Hassan Abdelnabi
Internal Medicine Department, Texas Tech University Health Science Center, Texas, USA.
Abdallah Almaghraby
Cardiology Department, Graz University, Graz, Austria.
*Author to whom correspondence should be addressed.
Abstract
Background: Revascularization of the coronary arteries is associated with better short term and long term prognosis in patients having multivessel coronary artery disease (MV-CAD) and chronic kidney disease (CKD). However, whether revascularization using coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) using drug eluting stents (DES) is better remains unknown.
Objectives: To compare the outcomes of revascularization by multi-vessel PCI using DES versus revascularization by CABG in patients with CKD having multivessel CAD, regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE).
Methods: This was a retrospective analysis of the data of a group of patients having CKD with eGFR less than 60 ml/min with multivessel CAD who underwent revascularization by PCI or revascularization by CABG and were compared as regards in-hospital and one-year MAACE.
Results: A total of 565 patients were reviewed in this study, 230 patients had multivessel PCI using DES while 335 patients had CABG. Comparing both revascularization groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital mortality, cerebrovascular events (stroke/TIA) and lower total MACCE than patients who had CABG (P-value = 0.03 & 0.01 & 0.04 respectively). When comparing both revascularization groups regarding one-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than those patients who had CABG (P-value = 0.02 & 0.03 respectively).
Conclusion: This is a retrospective study to determine which strategy is better for revascularization of CKD patients having multivessel CAD; we can conclude that multi-vessel PCI using DES for CKD patients and multivessel CAD had advantages over CABG regarding in-hospital and one-year cerebrovascular accidents (TIA/stroke) and regarding total MACCE. Larger randomized controlled trials are required to confirm our findings.
Keywords: Multivessel coronary artery disease, chronic kidney disease, percutaneous coronary intervention, coronary artery bypass grafting