Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stent Implantation in Patients With Chronic Kidney Disease: A Propensity Score Matching Study

Yang Li; XueJian Hou; TaoShuai Liu; Shijun Xu; Zhuhui Huang; XiaoYu Xu; Ran Dong

doi:10.3389/fcvm.2022.802181

Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stent Implantation in Patients With Chronic Kidney Disease: A Propensity Score Matching Study

Front Cardiovasc Med. 2022 Apr 1:9:802181. doi: 10.3389/fcvm.2022.802181. eCollection 2022.

Authors

Yang Li¹, XueJian Hou¹, TaoShuai Liu¹, Shijun Xu¹, Zhuhui Huang¹, XiaoYu Xu², Ran Dong¹

Affiliations

¹ Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Objectives: To compare the long-term outcomes of coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for coronary artery disease (CAD) patients with chronic kidney disease (CKD).

Methods: Coronary artery disease patients with decreased kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m²) who underwent CABG (n = 533) or PCI with DES (n = 952) from 2013 to 2020 were enrolled at a single center. The baseline characteristics and clinical outcomes were compared between the CABG and PCI groups for each matched pair of patients with CKD. The primary endpoint was the occurrence of all-cause death. The secondary endpoints were major adverse cardiovascular events (MACCEs) such as death, myocardial infarction (MI), stroke, and repeat revascularization.

Results: A total of 1,485 patients underwent revascularization, such as 533 CABG and 952 patients with PCI. The median follow-up duration was 55.6 months (interquartile range 34.3-74.7 months). Multivariable Cox regression models were used for risk adjustment, and after propensity score matching (PSM), 399 patients were well matched in each group. The in-hospital mortality rate in the CABG group was higher than that in the PCI group, but the difference was not statistically significant (5.0 vs. 2.5%, p = 0.063). At the 1-year follow-up, CABG was associated with a lower survival rate than PCI (94.2 vs. 98.0%, hazard ratio [HR] of 3.72, 95% CI = 1.63-8.49, p < 0.01). At the end of the 5-year follow-up, the freedom from MI and the freedom from repeated revascularization were both better in the CABG group compared to the PCI group (89.1 vs. 81.7%, HR of 0.59, 95% CI = 0.38-0.92, p = 0.019; 86.9 vs. 73.8%, HR of 0.54, 95% CI = 0.36-0.81, p = 0.003, respectively). Furthermore, the freedom from MACCEs was also better in the patients of CABG compared with the patients of PCI (58.5 vs. 51.3%, HR of 0.71, 95% CI = 0.55-0.91, p = 0.030). CABG had a higher cumulative survival rate (68.4 vs. 66.0%) but without a statistically significant difference (HR of 0.92, 95% CI = 0.67-1.27, p = 0.602) compared with that of PCI.

Conclusions: Compared to the use of PCI with a drug-eluting stent among patients with CKD, the use of CABG was associated with a lower MI rate, repeat revascularization rate, and lower number of MACCEs during the long-term follow-up. At a follow-up of 1 year, the number of MACCEs and other adverse events were comparable between the two cohorts, but CABG showed a lower survival rate than PCI.

Keywords: chronic kidney disease; coronary artery bypass grafting; coronary artery disease; percutaneous coronary intervention; propensity score matching.