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Propensity-matched comparison of drug-eluting stent implantation and coronary artery bypass graft surgery in chronic hemodialysis patients

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Abstract

Background

Cardiovascular disease is an important cause of death in patients with end-stage renal disease. Although coronary artery bypass graft (CABG) surgery and drug-eluting stent (DES) implantation have been compared in chronic hemodialysis patients, the results are unclear.

Methods

The study population consisted of chronic hemodialysis patients (dialysis duration >6 months) with coronary artery disease who underwent DES implantation or CABG at the Asan Medical Center (Seoul, Korea) between January 1, 2003, and February 28, 2006. We followed them until December, 2012. The mean follow-up was 50.91 ± 31.86 months for DES patients and 50.63 ± 36.43 months for CABG patients. Primary end points were major adverse cardiac and cerebral events (MACCE). Propensity-score matching was used to reduce selection bias and variable characteristics.

Results

Of 87 chronic hemodialysis patients with coronary artery disease, 44 underwent DES implantation and 43 underwent CABG surgery. Multivessel disease patients were 70.45 % in the DES group and 95.35 % in the CABG group. After propensity score adjustment, the MACCE-free survival was significantly higher in the CABG group than in the DES group (HR 3.265; 95 % CI 1.357–7.858; p = 0.008), but overall survival did not differ between the groups (HR 0.968; 95 % CI 0.267–3.507; p = 0.960).

Conclusion

We found that, compared with DES, CABG showed significantly better MACCE-free survival in chronic hemodialysis patients.

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Acknowledgments

This study was supported by Baxter.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea

    Chung Hee Baek & Soon Bae Kim

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seon-Ok Kim

  3. Division of Cardiology, Department of Internal Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seung-Jung Park

  4. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jae Won Lee

  5. Division of Nephrology, Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences (DIRAMS), 267-2 Jwadong-ri, Jangan-eup, Gijang-gun, Busan, 619-953, Republic of Korea

    Kyung Min Kim

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  1. Chung Hee Baek
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Correspondence to Kyung Min Kim.

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Baek, C.H., Kim, SO., Park, SJ. et al. Propensity-matched comparison of drug-eluting stent implantation and coronary artery bypass graft surgery in chronic hemodialysis patients. J Nephrol 27, 87–93 (2014). https://doi.org/10.1007/s40620-013-0023-2

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  • DOI: https://doi.org/10.1007/s40620-013-0023-2

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