A COMPARISON OF CORONARY-ARTERY BYPASS-GRAFTING AND PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN PATIENTS ON HEMODIALYSIS

The hospital records of 22 patients on hemodialysis undergoing coronar y artery bypass grafting. and 19 others undergoing percutaneous transl uminal coronary angioplasty were reviewed to compare the outcomes of t hese procedures in this population, Evidence of previous myocardial in farction or triple vessel or left main coronary artery disease was mor e common in patients undergoing coronary artery bypass graft than thos e undergoing percutaneous transluminal coronary angioplasty. Periopera tive mortality and complication rates following coronary artery bypass graft (4.5% and 41%, respectively) were similar to those following pe rcutaneous transluminal coronary angioplasty (5.3% and 42%). Cardiac e vent-free rates at 18 months by life-table analysis following coronary artery bypass graft and percutaneous transluminal coronary angioplast y were 87 +/- 16% and 40 +/- 14%, respectively. Survival at 18 months were 67 +/- 17% following coronary artery bypass graft and 69 +/- 14% following percutaneous transluminal coronary angioplasty. Cardiac even ts were observed to occur in three patients undergoing coronary artery bypass graft at a median of 10 months, and in nine patients following percutaneous transluminal coronary angioplasty at a median of 6 month s. One patient required percutaneous transluminal coronary angioplasty after the initial coronary artery bypass graft. Seven patients requir ed repeat percutaneous transluminal coronary angioplasty. and two pati ents underwent coronary artery bypass graft after initial percutaneous transluminal coronary angioplasty. Although these conclusions are lim ited by the retrospective nature of the study, it is concluded that co ronary artery bypass graft can be performed with morbidity and mortali ty equivalent to percutaneous transluminal coronary angioplasty, and p rovides better cardiac event-free rates than percutaneous transluminal coronary angioplasty in patients on hemodialysis. Percutaneous transl uminal angioplasty does not appear to be justified in this population because of its unacceptably high restenosis and cardiac event rates. ( C) 1998 The international Society for Cardiovascular Surgery. Publishe d by Elsevier Science Ltd. All rights reserved.