15th December 2017, Volume 130 Number 1467

Helen Pilmore, Mark Webster, Karishma Sidhu, Gajan Srikumar

The incidence of end-stage renal failure (ESRF) is increasing worldwide. Although renal transplantation improves survival compared with dialysis, cardiac disease remains a leading cause of death in patients after a…

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Summary

Coronary artery disease is common in patients with end-stage renal failure (ESRF). We assessed survival and cardiovascular outcomes in patients with ESRF undergoing coronary angiography and then having coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI) or medical management. Two hundred and eighty-eight patients had a total of 382 diagnostic coronary angiograms. There was no significant difference in survival between treatment modalities in the entire cohort, nor in the 108 patients with severe coronary artery disease. Similarly, there was no difference in the incidence of major adverse cardiac events, comparing medical management with revascularisation.

Abstract

Aim

Coronary artery disease is common in patients with end-stage renal failure (ESRF). However, there is little evidence that revascularisation improves outcomes, compared with medical management. This study assessed survival and cardiovascular outcomes in patients with ESRF undergoing coronary angiography and then having coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI) or medical management.

Method

Survival and major adverse cardiac events (MACE) were examined in all patients with ESRF who underwent coronary angiography at Auckland City Hospital between 2003 and 2012. Outcomes of patients who underwent revascularisation (CABG or PCI) were compared with those managed medically.

Results

Two hundred and eighty-eight patients with ESRF had a total of 382 diagnostic coronary angiograms. Ninety-one (32%) patients underwent revascularisation (61 PCI, 30 CABG), with the other 197 (68%) treated medically or requiring no specific cardiac treatment. The median survival was 3.3 (IQR 2.1–5.3) years in patients undergoing CABG, 2.9 (IQR 1.5–5.4) years in patients treated with PCI and 2.9 (IQR 1.3–5.5) years in patients managed medically. There was no significant difference in survival between treatment modalities in the entire cohort, nor in the 108 patients with triple vessel disease. Similarly, there was no difference in the incidence of major adverse cardiac events, comparing medical management with revascularisation.

Conclusion

There was no apparent survival advantage with revascularisation by either CABG or PCI, compared with medical management, in patients with ESRF undergoing coronary angiography. This study confirms the poor prognosis of patients with ESRF and coronary disease. Observational studies cannot control for all potential confounders; randomised trial data are needed to guide optimal management of this high-risk patient cohort.

Author Information

Helen Pilmore, Department of Renal Medicine, University of Auckland, Auckland;
Mark Webster, Cardiology, Auckland; Karishma Sidhu, Biostatistics, Auckland City Hospital, Auckland; Gajan Srikumar, University of Auckland, Auckland.

Acknowledgements

This study was supported partly by a research grant from ADHB and A+ Trust awarded to Gajan Srikumar. 

Correspondence

Dr Helen Pilmore, Department of Renal Medicine, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023.

Correspondence Email

hpilmore@adhb.govt.nz

Competing Interests

Dr Srikumar reports grants from ADHB & A+ Trust during the conduct of the study.

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