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CABG Outperforms PCI in Patients on Dialysis
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In a cohort of more than 20,000 patients with CHD who were on dialysis, CABG led to lower rates of all-cause death when compared with PCI.
The study included patients (n=21,981) from the United States Renal Data System, a database of all patients on dialysis in the United States with primary Medicare coverage. Patients received initial coronary revascularization with either multivessel CABG or PCI between 1997 and 2009 and had at least 6 months of prior Medicare coverage as their primary payer.
Overall, 5-year survival for patients was low — 22% to 25% — regardless of revascularization strategy. Multivariable-adjusted proportional hazards regression analysis revealed that CABG compared with PCI led to a significantly lower risk for all-cause death (HR=0.87; 95% CI, 0.84-0.90) and the composite of all-cause death or MI (HR=0.88; 95% CI, 0.86-0.91). Results were similar in analyses using a propensity score-matched cohort.
Tara Chang
“It is important to note that because our study was observational, our results cannot prove that CABG is better; only a randomized trial can do that,” said Tara Chang, MD, investigator with Stanford University School of Medicine, in an accompanying press release. “However, our study does offer guidance to patients and providers who must make these tough decisions and suggests that in carefully selected patients on dialysis with multivessel CHD, CABG may be preferred rather than PCI.”