By Maggie Schwarz
PHILADELPHIA -- November 14, 2008 -- Although use of drug-eluting stents in dialysis patients is associated with the best 1-year survival, long-term survival is better in patients receiving coronary artery bypass graft (CABG) surgery and the survival advantage of surgery is increased with greater numbers of arteries bypassed, according to a comparative study.
Charles Herzog, MD, Cardiovascular Studies Center, US Renal Data System, and Hennepin County Medical Center, Minneapolis, Minnesota, and colleagues compared the survival of dialysis patients undergoing stenting or bypass surgery. He reported the results on November 8 here at Renal Week 2008, the American Society of Nephrology (ASN) annual meeting.
Cardiovascular disease is the major cause of death in patients on dialysis. Therapies used to treat these patients include CABG surgery and drug-eluting stents. There are few published comparisons of survival of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents, Dr. Herzog explained.
Therefore, his research team evaluated outcomes on 13,066 dialysis patients treated with CABG, non-drug-eluting stents, or drug-eluting stents from 2003 to 2005. These were patients undergoing their first coronary revascularization procedure after developing advanced kidney disease. There were 3,665 patients receiving CABG, 6,164 receiving drug-eluting stents, and 3,237 receiving non-drug-eluting stents.
Survival rates at 1 year were 66.6% for CABG, 69.7% for drug-eluting stents, and 63.6% for non-drug-eluting stents. Survival rates at 3 years were 42.0%, 38.1%, and 34.5%, respectively.
Significant predictors of death were age 65 years or more, black race, congestive heart failure, peritoneal dialysis, diabetes, and non-drug-eluting stents (vs CABG).
Among CABG patients, mortality decreased when 4 or more arteries were bypassed (vs 1 artery; P = .0028) and with use of internal mammary artery grafting (P = .0081).
"Different patients might view this information in different ways," Dr. Herzog said. "For example, if patients wish to maximize their chance of a better short-term result with less in-hospital risk, they may choose drug-eluting stents. On the other hand, some patients may choose to maximize their long-term survival while risking higher in-hospital complications and worse short-term survival."
[Presentation title: Long-Term Survival of Dialysis Patients Undergoing Off-Pump Versus On-Pump Coronary Artery Bypass Surgery in the United States. Abstract SA-PO2720]
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