論文

査読有り
2014年8月

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)

AMERICAN JOURNAL OF CARDIOLOGY
  • Akira Marui
  • ,
  • Takeshi Kimura
  • ,
  • Noboru Nishiwaki
  • ,
  • Kazuaki Mitsudo
  • ,
  • Tatsuhiko Komiya
  • ,
  • Michiya Hanyu
  • ,
  • Hiroki Shiomi
  • ,
  • Shiro Tanaka
  • ,
  • Ryuzo Sakata

114
4
開始ページ
555
終了ページ
561
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1016/j.amjcard.2014.05.034
出版者・発行元
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC

Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p <0.001) and left main disease (10% vs 34%, p <0.001). Preprocedural Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score in the CABG group was significantly higher than that in the PCI group (23.5 +/- 8.7 vs 29.4 +/- 11.0, p <0.001). Unadjusted 30-day mortality was 2.7% for PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33,95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (BR 2.10,95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83,95% CI 1201 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p <0.001). Aiming the 201 patients who died during the follow-up, 94 patients (47%) died from noncardiac morbidities such as stroke, respiratory failure, and renal failure. In patients with multivessel and/or left main disease undergoing dialysis, 5-year outcomes revealed that CABG relative to PCI reduced the risk of cardiac death, sudden death, myocardial infarction, and any revascularization. However, the risk of all-cause death was not different between. PCI and CABG. (C) 2014 Elsevier Inc. All rights reserved.

リンク情報
DOI
https://doi.org/10.1016/j.amjcard.2014.05.034
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000340442600009&DestApp=WOS_CPL
ID情報
  • DOI : 10.1016/j.amjcard.2014.05.034
  • ISSN : 0002-9149
  • eISSN : 1879-1913
  • Web of Science ID : WOS:000340442600009

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