Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database


Internal Medicine

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Publication Title

Expert Review of Cardiovascular Therapy


Background: The role of PCI vs. CABG in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown.

Research design & methods: The National Inpatient Sample (NIS) (2002-2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs. CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated.

Results: A total of 350,623 [CABG=112,099 (32%) and PCI=238524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25-1.31, p=<0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93-5.47, P=<0.0001), sepsis (aOR 1.29, 95% CI 1.26-1.33, P=<0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20-1.26, P=<0.0001) and in-hospital mortality (aOR 1.65, 95% CI 1.61-1.69, P=<0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45-2.59, P=<0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94-1.06, P=0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization.

Conclusion: CABG in ESRD may be associated with higher in-hospital complications, increased length of stay and higher resource utilization.



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See full list of authors at https://pubmed.ncbi.nlm.nih.gov/34275404/