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Karkhanis R, Tam DY, Fremes SE. Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention. Curr Opin Cardiol. 2018;33(5):546-550doi: 10.1097/HCO.0000000000000539.
Karkhanis, R., Tam, D. Y., & Fremes, S. E. (2018). Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention. Current opinion in cardiology, 33(5), 546-550. https://doi.org/10.1097/HCO.0000000000000539
Karkhanis, Reena, et al. "Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention." Current opinion in cardiology vol. 33,5 (2018): 546-550. doi: https://doi.org/10.1097/HCO.0000000000000539
Karkhanis R, Tam DY, Fremes SE. Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention. Curr Opin Cardiol. 2018 Sep;33(5):546-550. doi: 10.1097/HCO.0000000000000539. PMID: 29965800.
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Curr Opin Cardiol. 2018 Sep;33(5):546-550. doi: 10.1097/HCO.0000000000000539.

Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention.

Current opinion in cardiology

Reena Karkhanis, Derrick Y Tam, Stephen E Fremes

Affiliations

  1. Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

PMID: 29965800 DOI: 10.1097/HCO.0000000000000539

Abstract

PURPOSE OF REVIEW: Coronary artery disease is common in patients with end-stage renal disease (ESRD) on hemodialysis. ESRD patients are prone to atherosclerosis and are likely to present with advanced CAD requiring coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).

RECENT FINDINGS: Individual observational studies and aggregated results comparing PCI to CABG have shown an increased risk of early postoperative mortality in the CABG group followed by a decrease in late mortality and cardiovascular events. Drug eluting stents are preferred to bare metal stents in patients undergoing PCI. Bilateral versus single internal thoracic arterial grafting strategies showed no difference in survival, freedom from cardiac death or freedom from cardiac events. There was no clear survival advantage to off-pump CABG over on-pump CABG in ESRD patients. Evidence to support either CABG or PCI was limited to retrospective observational studies that were at risk for treatment allocation bias.

SUMMARY: CABG carries an upfront risk of increased perioperative mortality while demonstrating late survival benefit compared with PCI. Thus, in the context of balancing these competing risks and benefits, deciding on the most appropriate treatment in this high-risk cohort is challenging. Comprehensive patient evaluation by a multidisciplinary team is strongly recommended.

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