A COMPARISON OF CORONARY ANGIOPLASTY AND CORONARY-ARTERY BYPASS-GRAFTING OUTCOMES IN CHRONIC DIALYSIS PATIENTS

The objective of this study was to compare the outcomes of angina, myo cardial infarction (MI), cardiac death, and all-cause death following percutaneous transluminal coronary angioplasty (PTCA) or coronary arte ry bypass grafting (CABG). The study design was based on retrospective , nonrandomized analysis and was set in referral teaching hospitals an d community hospitals. Eighty-four chronic dialysis patients with symp tomatic coronary artery disease without prior revascularization were i ncluded in the study. Twenty-four patients underwent PTCA of one or mo re vessels, and 60 patients underwent CABG. Recurrence of angina, MI, cardiac death, and all-cause death following revascularization as well as the number of inpatient days preprocedure and postprocedure were r ecorded. The two patient groups were comparable in terms of age, sex, history of MI, left ventricular mass and function, and angina severity . Diabetes mellitus was more prevalent in the PTCA group. The CABG gro up had more severe coronary artery disease. The P-year survival rate o f the CABG patients (66%; 95% confidence interval = 53,79) did not dif fer from that of the PTCA patients (51%; 95% confidence interval = 27, 65). Thirteen PTCA patients were restudied 106 +/- 108 days after recu rrence of angina; nine (69%) of these patients were found to have angi ographic restenosis. The postprocedure risk of angina and the combined endpoints of angina, MI, and cardiovascular death were significantly greater following PTCA than CABG. Percutaneous transluminal coronary a ngioplasty was the only consistent predictor of outcomes; the adjusted relative risks (compared with CABG) of postprocedure angina and combi ned endpoints were 16.4 and 10.2, respectively, and were several-fold higher than the unadjusted risks. We conclude that in chronic dialysis patients with symptomatic coronary disease, patients undergoing PTCA have a higher risk of subsequent angina and combined angina, MI, and c ardiovascular death than those undergoing CABG. The optimal approach t o coronary revascularization in this patient population remains to be determined. (C) 1995 by the National Kidney Foundation, Inc.