Ix Joachim H, Mercado Nestor, Shlipak Michael G, Lemos Pedro A, Boersma Eric, Lindeboom Wietze, O'Neill William W, Wijns William, Serruys Patrick W
Department of Medicine, University of California, San Francisco, Calif, USA.
Am Heart J. 2005 Mar;149(3):512-9. doi: 10.1016/j.ahj.2004.10.010.
Chronic kidney disease (CKD) is associated with adverse outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI), but it is unclear which of these revascularization strategies is associated with lower risk for morbidity and mortality in this population. In the Arterial Revascularization Therapies Study (ARTS), we compared long-term clinical outcomes after CABG or PCI with multivessel stenting in patients with CKD.
The ARTS randomly assigned 1205 participants with and without CKD to CABG or PCI with multivessel stenting. We defined CKD as creatinine clearance < or =60 mL/min, estimated by the Cockroft-Gault equation. The primary outcome was the composite of death, myocardial infarction (MI), or stroke; and, a secondary outcome was repeat revascularization. Participants were followed for a mean of 3 years after their intervention. We evaluated whether randomization to CABG or PCI was associated with different outcomes among participants with CKD.
Two hundred ninety participants (25%) had CKD at entry into ARTS. One hundred fifty-one received PCI, and 139 received CABG. No difference was observed in the primary endpoint with CABG or PCI among CKD participants (adjusted Hazard Ratio [HR] CABG vs PCI = 0.93; 95% CI 0.54-1.60; P = .97). However, CABG was associated with a reduced risk for repeat revascularization (HR = 0.28; 95% CI 0.14-0.54; P < .01). Compared with participants with normal renal function, CKD was associated with a nearly 2-fold risk for the primary outcome (unadjusted HR = 1.9; 95% CI 1.4-2.7; P < .01). After multivariate adjustment, this association remained significant (HR 1.6; 95% CI 1.1-2.4).
In patients with multivessel CAD and CKD, treatment with CABG or PCI with multivessel stenting led to similar outcomes of death, MI, or stroke, but CABG was associated with decreased repeat revascularizations. When compared with ARTS participants with normal renal function, those with CKD had substantially elevated risk of adverse clinical outcomes after coronary revascularization.
慢性肾脏病（CKD）与冠状动脉搭桥手术（CABG）及经皮冠状动脉介入治疗（PCI）后的不良预后相关，但尚不清楚这两种血运重建策略中哪种与该人群较低的发病和死亡风险相关。在动脉血运重建治疗研究（ARTS）中，我们比较了CKD患者接受CABG或PCI联合多支血管支架置入后的长期临床结局。
ARTS将1205例有或无CKD患者随机分配至CABG组或PCI联合多支血管支架置入组。我们将CKD定义为根据Cockcroft - Gault公式估算的肌酐清除率≤60 mL/分钟。主要结局为死亡、心肌梗死（MI）或卒中的复合结局；次要结局为再次血运重建。干预后对参与者平均随访3年。我们评估了随机分配至CABG或PCI组在CKD参与者中是否与不同结局相关。
290例参与者（25%）在进入ARTS时患有CKD。151例接受PCI，139例接受CABG。CKD参与者中，CABG或PCI组在主要终点方面未观察到差异（CABG与PCI的校正风险比[HR] = 0.93；95%可信区间0.
