초록접수 현황
| 15F-157 | 구연 발표 |
Long-term Outcomes of Off-pump Coronary Artery Bypass Versus Percutaneous Coronary Intervention in Patients with Chronic Kidney Disease
Chan-Kyu Lee, Hyun-Chel Joo, Seung Hyun Lee, Kyung-Jong Yoo, Young-Nam Youn
Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Background : Advances in percutaneous coronary intervention (PCI) using drug-eluting stents (DES) have impacted clinical practice. However, the efficacy of PCI for chronic kidney disease (CKD) patients still remains controversial. This study compares the mid-term clinical outcomes of off pump coronary artery bypass grafting (OPCAB) and PCI with DES in CKD patients
Methods : From January 2003 to February 2012, 287 multi-vessel coronary patients with CKD underwent OPCAB or PCI with DES as their initial revascularization therapy (OPCAB group (n=139) vs PCI group (n=148)). CKD was defined as estimated glomerular filtration rate of < 60ml/min/1.73m2. Emergency and life-saving procedures were excluded. Study end-points were overall survival, and major adverse cardiac and cerebrovascular event (MACCE). Mean follow-up duration was 56 ± 36.5 months and follow up rate was 94.1%.
Results : Preoperative characteristics and risk factors were compatible between the groups except for the smoke history and peripheral occlusive disease. Early mortality was not different between the two groups (PCI 5.0 % vs OPCAB 3.4 %, p= 0.483). The percentage of conversion to permanent dialysis was 11.2 % in PCI and 13.5 % in OPCAB (p=0.59). At 10 year follow-up, PCI group showed higher incidences of overall mortality (PCI 39.6% vs OPCAB 25.7%, p=0.012), stroke (7.9% vs 2.7%, p=0.047) and TVR (18.7% vs 4.7%, p<0.001). Incidences of late MI was not different between the two groups (PCI 5.8% vs OPCAB 2.0%, p=0.1). Overall survival at 10 year was 56.6±0.46% in the PCI group and 68.1±0.47% in the OPCAB group. (p=0.04). The 10-year free from MACCEs was 36.4±0.48% in the PCI group and 61.5±0.5% in the OPCAB group at 10 years (p<0.01). Cox regression analysis showed that the PCI (vs OPCAB) was independent risk factor of late mortality (HR 2.41, CI 1.44-4.01, p=0.001) and MACCEs (HR 2.52, CI 1.64-3.67, p<0.001).
Conclusion : This study showed initial strategy of OPCAB would be associated with lower risks of long-term mortality and major adverse events compared with PCI for the treatment of coronary patients with chronic kidney disease.
Methods : From January 2003 to February 2012, 287 multi-vessel coronary patients with CKD underwent OPCAB or PCI with DES as their initial revascularization therapy (OPCAB group (n=139) vs PCI group (n=148)). CKD was defined as estimated glomerular filtration rate of < 60ml/min/1.73m2. Emergency and life-saving procedures were excluded. Study end-points were overall survival, and major adverse cardiac and cerebrovascular event (MACCE). Mean follow-up duration was 56 ± 36.5 months and follow up rate was 94.1%.
Results : Preoperative characteristics and risk factors were compatible between the groups except for the smoke history and peripheral occlusive disease. Early mortality was not different between the two groups (PCI 5.0 % vs OPCAB 3.4 %, p= 0.483). The percentage of conversion to permanent dialysis was 11.2 % in PCI and 13.5 % in OPCAB (p=0.59). At 10 year follow-up, PCI group showed higher incidences of overall mortality (PCI 39.6% vs OPCAB 25.7%, p=0.012), stroke (7.9% vs 2.7%, p=0.047) and TVR (18.7% vs 4.7%, p<0.001). Incidences of late MI was not different between the two groups (PCI 5.8% vs OPCAB 2.0%, p=0.1). Overall survival at 10 year was 56.6±0.46% in the PCI group and 68.1±0.47% in the OPCAB group. (p=0.04). The 10-year free from MACCEs was 36.4±0.48% in the PCI group and 61.5±0.5% in the OPCAB group at 10 years (p<0.01). Cox regression analysis showed that the PCI (vs OPCAB) was independent risk factor of late mortality (HR 2.41, CI 1.44-4.01, p=0.001) and MACCEs (HR 2.52, CI 1.64-3.67, p<0.001).
Conclusion : This study showed initial strategy of OPCAB would be associated with lower risks of long-term mortality and major adverse events compared with PCI for the treatment of coronary patients with chronic kidney disease.
책임저자: Young-Nam Youn
Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
연락처 : Chan-Kyu Lee, Tel: 02-228-8494 , E-mail : apolo1980@yuhs.ac
