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

ABSTRACT

Background

The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (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 = 238,524 (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.

KEYWORDS:

• percutaneous coronary intervention
• coronary artery bypass grafting
• end-stage renal disease
• coronary artery disease

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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