Pak J Med Sci. 2014 Nov-Dec;30(6):1180-5. doi: 10.12669/pjms.306.5540.
Mode of Coronary Revascularization and Short term Clinical Outcomes in Patients with Chronic Kidney Disease.
Pakistan journal of medical sciences
Ashique Ali Khoso, Khawar Abbas Kazmi, Saqiba Tahir, Hasanat Sharif, Safia Awan
Affiliations
Affiliations
- Ashique Ali Khoso, Senior Instructor, Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
- Khawar Abbas Kazmi, Professor and Section Head of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
- Saqiba Tahir, Medical Student, Aga Khan University, Karachi, Pakistan.
- Hasanat Sharif, Associate Professor and Section Head of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan.Department of Surgery, Aga Khan University Hospital.
- Safia Awan, Statistician, Department of Medicine, Aga Khan University, Karachi, Pakistan.
PMID: 25674104
PMCID: PMC4320696 DOI: 10.12669/pjms.306.5540
Abstract
BACKGROUND AND OBJECTIVE: Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients.
METHODS: In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction (MI), or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes.
RESULTS: Out of 159 patients with CKD, 85 (53.5%) received PCI and 74 (46.5%) received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD.
CONCLUSION: Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD.
Keywords: Chronic kidney disease; Coronary artery bypass graft; Coronary revascularization; Creatinine clearance; Percutaneous coronary intervention
References
- J Am Soc Nephrol. 2003 Sep;14(9):2373-80 - PubMed
- Circulation. 2000 Dec 12;102(24):2966-72 - PubMed
- Cardiovasc Surg. 1998 Oct;6(5):500-5 - PubMed
- Am J Med. 1997 Nov;103(5):368-75 - PubMed
- Circulation. 1976 Sep;54(3):522-3 - PubMed
- Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266 - PubMed
- Circulation. 1989 Aug;80(2):410-4 - PubMed
- Catheter Cardiovasc Interv. 2002 Jan;55(1):66-72 - PubMed
- JAMA. 2007 Nov 7;298(17):2038-47 - PubMed
- Ann Intern Med. 2002 Oct 1;137(7):555-62 - PubMed
- Circulation. 2003 Dec 2;108(22):2769-75 - PubMed
- Nephron. 1976;16(1):31-41 - PubMed
- Kidney Int. 1999 Mar;55(3):1057-62 - PubMed
- Am Heart J. 2005 Mar;149(3):512-9 - PubMed
- Circulation. 1991 Feb;83(2):492-503 - PubMed
- Am J Cardiol. 2003 Sep 1;92(5):509-14 - PubMed
- Eur J Intern Med. 2013 Jun;24(4):354-61 - PubMed
- Circ J. 2007 Aug;71(8):1299-304 - PubMed
- Circ Cardiovasc Interv. 2009 Aug;2(4):309-16 - PubMed
- Kidney Int. 2001 Jul;60(1):292-9 - PubMed
Publication Types