Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

• Published in: Kidney & blood pressure research Vol. 48; no. 1; pp. 545 - 555
• Main Authors: Daoulah, Amin, Taha Baqais, Rasha, Aljohar, Alwaleed, Alhassoun, Abdulkarim, Hersi, Ahmad S., Almahmeed, Wael, Yousif, Nooraldaem, Alasmari, Abdulaziz, Alshehri, Mohammed, Eltaieb, Fakhreldein, Alzahrani, Badr, Elmahrouk, Ahmed, Arafat, Amr A., Jamjoom, Ahmed, Alshali, Khalid Z., Abuelatta, Reda, Ahmed, Waleed A., Alqahtani, Abdulrahman H., Al Garni, Turki, Hashmani, Shahrukh, Dahdouh, Ziad, Refaat, Wael, Kazim, Hameedullah M., Ghani, Mohamed Ajaz, Amin, Haitham, Hiremath, Niranjan, Elmahrouk, Youssef, Selim, Ehab, Aithal, Jairam, Qutub, Mohammed A., Alama, Mohamed N., Ibrahim, Ahmed M., Elganady, Abdelmaksoud, Abohasan, Abdulwali, Asrar, Farhan M., Farghali, Tarek, Jameel Naser, Maryam, Hassan, Taher, Balghith, Mohammed, Hussien, Adnan Fathey, Abdulhabeeb, Ibrahim A.M., Ahmad, Osama, Ramadan, Mohamed, Ghonim, Ahmed A., Shawky, Abeer M., Noor, Husam A., Haq, Ejazul, Alqahtani, Abdulrahman M., Al Samadi, Faisal, Abualnaja, Seraj, Khan, Mushira, Alhamid, Sameer, Lotfi, Amir
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 2023; Karger Publishers
• Subjects: Angioplasty; Body mass index; Bypass; Cardiac arrest; Cardiac arrhythmia; Cardiovascular disease; Coronary artery; coronary artery bypass grafting; Coronary vessels; Diabetes; Grafting; gulf; Heart surgery; Hospitals; Hypertension; impaired renal function; Kidney diseases; left main coronary artery; Medical prognosis; Metabolic disorders; outcomes; Patients; percutaneous coronary intervention; Regression analysis; Renal function; Research Article; Vein & artery diseases; Percutaneous coronary intervention; Gulf; Left main coronary artery; Coronary artery bypass grafting; Impaired renal function; Outcomes
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000533141

Abstract
Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.