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Coronary artery bypass surgery may provide improved long-term survival among patients with end-stage renal disease requiring revascularization procedure

Monday, November 17 2008 | Comments
Evidence Grade 7 What's This?
By Kiki Diven

New study findings indicate that coronary artery bypass surgery (CABG) appears to provide better long-term survival than drug-eluting stents (DES) and non-drug eluting stents (non-DES) among patients with end-stage renal disease (ESRD) who need a revascularization procedure.

For the retrospective trial, Dr. Charles Herzog and Craig Solid of the United States Renal Data System (USRDS) in Minneapolis, Minn., obtained data from the USRDS database on 13,066 patients on dialysis. All patients underwent either CABG surgery (n=3,665) or received DES (n=6,164) or non-DES (n=3,237) from 2003 through 2005.
 
The study estimated the long-term survival of the patients using the Kaplan-Meier method, and independent predictors of death were examined in a comorbidity-adjusted Cox model. Patients were followed up at 1, 6, 12, 24, and 36 months).

Although baseline characteristics were similar between the groups, there were more men in the CABG group (60.1%) than in the DES group (53.4%) and non-DES group (55.3%). There was also a greater percentage of patients aged 75 years or older in the non-DES group.

After the first year, the survival rate was highest in the DES group (69.7%) than in the CABG group (66.6%) and non-DES group (63.6%). However, by 24 months, the rate was highest among patients in the CABG group (53.4%) as compared with those in the DES (51.3%) and non-DES (46.6%) groups. After 3 years, the higher survival rate was maintained in the CABG group (42%) when compared to the DES (38.1%) and non-DES (34.5%) groups.

In patients who underwent CABG, the risk of death decreased further when 4 or more arteries were bypassed versus 1 artery (HR, 0.77; 95% CI, 0.65-0.91; P=.0028).

Predictors of death included having congestive heart failure (HR, 1.38; 95% CI,1.30-1.46; P<.0001), undergoing peritoneal dialysis (HR, 1.39; 95% CI,1.25-1.55; P<.0001), being aged 65 to 74 years (HR, 1.26; 95% CI, 1.19-1.34; P<.0001), and being aged 75 years or older (HR, 1.74; 95% CI, 1.64-1.86; P<.0001).

"Our data suggest that DES provides the best one-year survival in dialysis [patients], but unadjusted long-term survival is best after [coronary arterial bypass]...," the authors concluded.  (Abstract TH-FC045)

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