This Article Full Text Full Text (PDF) All Versions of this Article: 110/14/1890    most recent 01.CIR.0000143629.55725.D9v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hemmelgarn, B. R. Search for Related Content PubMed PubMed Citation Articles by Hemmelgarn, B. R. Related Collections Catheter-based coronary and valvular interventions: other CV surgery: coronary artery disease Epidemiology Related Article

(Circulation. 2004;110:1890-1895.)
© 2004 American Heart Association, Inc.

Cardiovascular Surgery

Survival After Coronary Revascularization Among Patients With Kidney Disease

Brenda R. Hemmelgarn, PhD, MD; Danielle Southern, MSc; Bruce F. Culleton, MD; L. Brent Mitchell, MD; Merril L. Knudtson, MD; William A. Ghali, MD, MPH, for the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Investigators^*

From the Departments of Medicine (B.R.H., B.F.C., L.B.M., M.L.K., W.A.G.) and Community Health Sciences (B.R.H., W.A.G.) and the Centre for Health and Policy Studies (D.S., W.A.G.), University of Calgary, Calgary, Alberta, Canada.

Correspondence to Dr Brenda Hemmelgarn, Division of Nephrology, Foothills Medical Center, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada. E-mail brenda.hemmelgarn{at}calgaryhealthregion.ca

Received May 27, 2004; revision received July 21, 2004; accepted August 2, 2004.

Background— The optimal approach to revascularization in patients with kidney disease has not been determined. We studied survival by treatment group (CABG, percutaneous coronary intervention [PCI], or no revascularization) for patients with 3 categories of kidney function: dialysis-dependent kidney disease, non–dialysis-dependent kidney disease, and a reference group (serum creatinine <2.3 mg/dL).

Methods and Results— Data were derived from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), which captures information on all patients undergoing cardiac catheterization in Alberta, Canada. Characteristics and patient survival in 662 dialysis patients (1.6%) and 750 non–dialysis-dependent kidney disease patients (1.8%) were compared with the remainder of the 40 374 patients (96.6%). For the reference group, the adjusted 8-year survival rates for CABG, PCI, and no revascularization (NR) were 85.5%, 80.4%, and 72.3%, respectively (P<0.001 for CABG versus NR; P<0.001 for PCI versus NR). Adjusted survival rates were 45.9% for CABG, 32.7% for PCI, and 29.7% for NR in the nondialysis kidney disease group (P<0.001 for CABG versus NR; P=0.48 for PCI versus NR) and 44.8% for CABG, 41.2% for PCI, and 30.4% for NR in the dialysis group (P=0.003 for CABG versus NR; P=0.03 for PCI versus NR).

Conclusions— Compared with no revascularization, CABG was associated with better survival in all categories of kidney function. PCI was also associated with a lower risk of death than no revascularization in reference patients and dialysis-dependent kidney disease patients but not in patients with non–dialysis-dependent kidney disease. The presence of kidney disease or dependence on dialysis should not be a deterrent to revascularization, particularly with CABG.

Key Words: revascularization • coronary disease • kidney • epidemiology

Related Article:

Circulation 2004 110: 1875. [Full Text]

This article has been cited by other articles:

				M. B. Chonchol, V. Aboyans, P. Lacroix, G. Smits, T. Berl, and M. Laskar Long-term outcomes after coronary artery bypass grafting: Preoperative kidney function is prognostic J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 683 - 689. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]

				N.C. Edwards, R.P. Steeds, C.J. Ferro, and J.N. Townend The treatment of coronary artery disease in patients with chronic kidney disease QJM, November 1, 2006; 99(11): 723 - 736. [Abstract] [Full Text] [PDF]

				N. G. Kutner, R. Zhang, Y. Huang, and C. A. Herzog Cardiac Rehabilitation and Survival of Dialysis Patients after Coronary Bypass J. Am. Soc. Nephrol., April 1, 2006; 17(4): 1175 - 1180. [Abstract] [Full Text] [PDF]

				W. A. Cooper, S. M. O'Brien, V. H. Thourani, R. A. Guyton, C. R. Bridges, L. A. Szczech, R. Petersen, and E. D. Peterson Impact of Renal Dysfunction on Outcomes of Coronary Artery Bypass Surgery: Results From the Society of Thoracic Surgeons National Adult Cardiac Database Circulation, February 28, 2006; 113(8): 1063 - 1070. [Abstract] [Full Text] [PDF]

				R. Zakeri, N. Freemantle, V. Barnett, G. W. Lipkin, R. S. Bonser, T. R. Graham, S. J. Rooney, I. C. Wilson, R. Cramb, B. E. Keogh, et al. Relation Between Mild Renal Dysfunction and Outcomes After Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-270 - I-275. [Abstract] [Full Text] [PDF]