Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database

Abstract

Background: The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown. Research design & methods: The National Inpatient Sample (NIS) (2002–2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated. Results: A total of 350,623 [CABG = 112,099 (32%) and PCI = 238,524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25–1.31, P < 0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93–5.47, P < 0.0001), sepsis (aOR 1.29, 95% CI 1.26–1.33, P < 0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20–1.26, P < 0.0001), and in-hospital mortality (aOR 1.65, 95% CI 1.61–1.69, P < 0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45–2.59, P < 0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94–1.06, P = 0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization. Conclusion: CABG in ESRD may be associated with higher in-hospital complications, increased length of stay, and higher resource utilization.