Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Coronary Artery Disease Patients with Advanced Chronic Kidney Disease: A Chinese Single-Center Study

Objectives Aims to compare the contemporary and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with advanced chronic kidney disease (CKD). Design Observational cohort study, single-center.Setting The largest cardiac surgery center in China.Participants 823 CAD patients with advanced CKD (eGFR<30 ml/min/1.73m2) were collected, including 247 patients who underwent CABG and 576 patients received PCI from January 2010 to February 2019. Main outcome measures The primary end point was all-cause death. The secondary end points included major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), stroke and revascularization.Results Multivariable Cox regression models were used for risk-adjustment and propensity score matching (PSM) was also performed. After PSM, the 30-day mortality rate in the CABG group was higher than that in the PCI group but without statistically significant (6.6%vs2.4%, p=0.0640). During the first year, patients referred for CABG had a hazard ratio (HR) of 1.42 [95% confidence interval (CI), 0.41–3.01] for mortality compared with PCI. At the end of the 5-year follow-up, CABG group had a HR of 0.58 (95%CI, 0.38-0.86) for repeat revascularization, a HR of 0.77 (95%CI, 0.52-1.14) for survival rate and a HR of 0.88(95%CI, 0.56-1.18) for MACCE as compared to PCI. Conclusions Our study suggests that among advanced CKD patients，CABG showed obviously lower risk for repeat revascularization and slightly better prognosis regarding to mortality and other adverse events compared with PCI during the long-term follow-up. At a mean pooled follow-up of one year, both mortality and MACCEs were comparable in both cohorts.