Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
EuroIntervention. 2018 May 20;14(1):102-111. doi: 10.4244/EIJ-D-17-00620.
The aim of this study was to investigate short-term and five-year follow-up results from patients randomised to coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with paclitaxel-eluting stents in the SYNTAX trial, focusing on patients with chronic kidney disease (CKD).
Baseline glomerular filtration rate estimates (eGFR) were available in 1,638 patients (PCI=852 and CABG=786). The Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to define staging of CKD. At five years, death was significantly higher in patients with CKD compared to patients with normal kidney function after PCI (26.7% vs. 10.8%, p<0.001) and CABG (21.2% vs. 10.6%, p=0.005). Comparing PCI with CABG, there was a significant interaction according to kidney function for death (pint=0.017) but not the composite endpoint of death/stroke/MI (pint=0.070) or MACCE (pint=0.15). In patients with CKD, the rate of MACCE was significantly higher after PCI compared with CABG (42.1% vs. 31.5%, p=0.019), driven by repeat revascularisation (21.9% vs. 8.9%, p=0.004) and all-cause death (26.7% vs. 21.2%, p=0.14). In patients with CKD who also had diabetes, PCI versus CABG was significantly worse in terms of death/stroke/MI (47.9% vs. 24.4%, p=0.005) and all-cause death (40.9% vs. 17.7%, p=0.004).
During a five-year follow-up, adverse event rates were comparable between PCI and CABG patients with moderate CKD but significantly higher compared to the patients with impaired or normal kidney function. The negative impact of CKD on long-term outcome following PCI appears to be stronger when compared to CABG, especially in the CKD patients with diabetes and extensive coronary disease.
本研究旨在探讨随机接受紫杉醇洗脱支架经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的患者的短期和五年随访结果，重点关注慢性肾脏病（CKD）患者。
1638 例患者（PCI=852 例，CABG=786 例）的基线肾小球滤过率估计值（eGFR）可用。采用肾脏病：改善全球预后（KDIGO）标准来定义 CKD 分期。五年时，与肾功能正常的 PCI 患者相比，CKD 患者的死亡率明显更高（26.7%比 10.8%，p<0.001）和 CABG（21.2%比 10.6%，p=0.005）。与 CABG 相比，根据肾功能，死亡的比较存在显著的交互作用（pint=0.017），但死亡/卒中/MI 的复合终点（pint=0.070）或 MACCE（pint=0.15）则不然。在 CKD 患者中，与 CABG 相比，PCI 后的 MACCE 发生率明显更高（42.1%比 31.5%，p=0.019），这主要是由于再次血运重建（21.9%比 8.9%，p=0.004）和全因死亡（26.7%比 21.2%，p=0.14）所致。在 CKD 合并糖尿病的患者中，与 CABG 相比，PCI 更差，在死亡/卒中/MI（47.9%比 24.4%，p=0.005）和全因死亡（40.9%比 17.7%，p=0.004）方面。
在五年随访期间，中重度 CKD 患者 PCI 和 CABG 之间的不良事件发生率相当，但与肾功能受损或正常的患者相比，发生率明显更高。与 CABG 相比，CKD 对 PCI 后长期预后的负面影响似乎更强，尤其是在 CKD 合并糖尿病和广泛冠状动脉疾病的患者中。
