CABG still the ‘gold standard’ for revascularization in patients with 3-vessel CAD and CKD
Coronary artery bypass grafting (CABG) is associated with much better long-term outcomes than percutaneous coronary intervention (PCI) when patients present with three-vessel coronary artery disease (TVD) and chronic kidney disease (CKD), according to a new analysis published in The American Journal of Cardiology.[1]
The mid-term benefits of CABG over PCI for this complex patient population has already been established, researchers noted, but they hoped to gain a better understanding of the long-term impact of choosing a surgical approach over an interventional one.
The study included data from more than 400 adult patients with angiography-confirmed TVD and glomerular filtration rate (GFR)-confirmed CKD who underwent treatment from 2009 to 2018 in Alberta, Canada. While 373 patients with a mean age of 71 years old underwent PCI, 80 patients with a mean age of 65 years old underwent CABG. The median follow-up period was 9.3 years, and the longest follow-up was 14.1 years.
Reviewing these long-term data, the authors confirmed that CABG was consistently linked to better patient outcomes than PCI. The study’s primary outcome—all-cause mortality up to the longest follow-up period—was 68.9% for CABG patients and 83.1% for PCI patients. Readmission for myocardial infarction at the longest follow-up (10.2% vs. 28.4%) and repeat revascularization at longest follow-up (3.1% vs. 24.4%) were also significantly lower for CABG compared to PCI.
The long-term rates of stroke and all-cause rehospitalization, however, were not significantly different between the two treatment strategies.
“These results align with previous literature but extend the evidence base out to longer follow-up intervals,” wrote first author Nicholas Fialka, MD, a cardiac surgery resident with the University of Alberta, and colleagues.
The authors also emphasized that morbidity and mortality rates after revascularization “remain very high” for patients with TVD and CKD.
“Given the growing evidence supporting surgical revascularization, we anticipate an increase in the number of patients with CKD undergoing CABG,” the group wrote. “Therefore, it will be essential to implement strategies to mitigate perioperative morbidity and renal dysfunction.”
Fialka et al. concluded with a reminder that multidisciplinary heart teams should still review care for all patients with TVD to help identify the best treatment strategy for that individual. There may be cases, for example, when PCI is a better option than CABG due to the patient’s anatomy or other outside factors.
Overall, however, CABG is going to be associated with better long-term outcomes than PCI for a majority of patients presenting for treatment.
“While further robust investigation is needed, there is a substantial body of evidence, bolstered by the present analysis, suggesting that CABG should be considered the gold standard approach to revascularization for patients with TVD and CKD,” the authors wrote.
Click here for the full analysis.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.