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  • Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI—analysis of routine statutory health insurance data

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Interventional cardiology
Original research article
Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI—analysis of routine statutory health insurance data
  1. Martin Möckel1,
  2. Julia Searle1,
  3. Henning Thomas Baberg2,
  4. Peter Dirschedl3,
  5. Benny Levenson4,
  6. Jürgen Malzahn5,
  7. Thomas Mansky6,
  8. Christian Günster7 and
  9. Elke Jeschke7
  1. 1Division of Emergency Medicine and Chest Pain Units, Department of Cardiology, Campus Virchow Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Berlin, Germany
  2. 2Department of Cardiology and Nephrology, Helios Klinikum, Berlin-Buch, Berlin, Germany
  3. 3Medical Service of the Health Funds (MDK) Baden-Württemberg, Lahr, Germany
  4. 4German Society of Cardiologists in Private Practise (BNK—Bundesverband niedergelassener Kardiologen), München, Germany
  5. 5Federal Association of the Local Health Care Funds (AOK), Berlin, Germany
  6. 6Faculty of Economics and Management, Division of Structural Development and Quality Management in Healthcare, Technische Universität Berlin, Berlin, Germany
  7. 7Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
  1. Correspondence to Professor Martin Möckel; martin.moeckel{at}charite.de

Abstract

Objectives We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy.

Design Retrospective analysis of routine statutory health insurance data between 2010 and 2012.

Main outcome measures Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year. Secondary outcomes were repeat revascularisation at 30 days and 1 year and bleeding events within 7 days.

Results The total number of cases was n=4123 (PCI; n=3417), median age was 71 (IQR 62–77), 30.4% were women. The adjusted OR for death within 30 days was 0.59 (95% CI 0.43 to 0.81) for patients undergoing PCI versus CABG. At 1 year, the adjusted OR for major adverse cardiac and cerebrovascular events (MACCE) was 1.58 (1.32 to 1.89) for PCI versus CABG and 1.47 (1.23 to 1.75) for all-cause death. In the subgroup of patients with acute myocardial infarction (AMI), adjusted all-cause mortality at 30 days did not differ significantly between both groups (OR 0.75 (0.47 to 1.20)), whereas in patients without AMI the OR for 30-day mortality was 0.44 (0.28 to 0.68) for PCI versus CABG. At 1 year, the adjusted OR for MACCE in patients with AMI was 1.40 (1.06 to 1.85) for PCI versus CABG and 1.47 (1.08 to 1.99) for mortality.

Conclusions In this cohort of unselected patients with ESRD undergoing revascularisation, the 1-year outcome was better for CABG in patients with and without AMI. The 30-day mortality was higher in non-AMI patients with CABG reflecting an early hazard with surgery. In cases where the patient's characteristics and risk profile make it difficult to decide on a revascularisation strategy, CABG could be the preferred option.

  • MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)
  • RENAL DISEASE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000464

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    Footnotes

    • Contributors MM, HTB, PD, BL, JM, TM, CG and EJ held regular meetings to discuss the clinical need, research question, study design and data interpretation. MM, EJ and JS drafted the manuscript, including tables and figures and held regular meetings on content of the manuscript and data interpretation. EJ and CG performed the statistical analysis. All authors read and revised the manuscript.

    • Competing interests All authors have completed the Unified Competing Interests form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that MM has grants from Radiometer Medical ApS, Denmark, grants and non-financial support from ThermoFisher Scientific/Brahms AG, grants from Roche Diagnostics, grants from Novartis, grants from Cardiorentis, outside the submitted work; JS has grants from Radiometer Medical ApS, Denmark, grants from ThermoFisher Scientific/Brahms AG, grants from Roche Diagnostics, grants from Novartis, grants from Cardiorentis, outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.