Pan Szu-Yu, Yang Ju-Yeh, Teng Nai-Chi, Chen Yun-Yi, Wang Shi-Heng, Lee Chien-Lin, Chen Kang-Lung, Chiu Yen-Ling, Hsu Shih-Ping, Peng Yu-Sen, Chen Yung-Ming, Lin Shuei-Liong, Chen Likwang
Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Kidney Med. 2023 Dec 5;6(2):100768. doi: 10.1016/j.xkme.2023.100768. eCollection 2024 Feb.
RATIONALE & OBJECTIVE: We aimed to study the comparative effectiveness of percutaneous coronary intervention with drug-eluting stent and coronary artery bypass grafting in patients receiving dialysis.
This was a retrospective observational cohort study.
SETTING & PARTICIPANTS: This population-based study identified patients receiving dialysis hospitalized for coronary revascularization between January 1, 2009 and December 31, 2015, in the Taiwan National Health Insurance Research Database.
Patients received percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting.
The study outcomes were all-cause mortality, in-hospital mortality, and repeat revascularization.
Propensity scores were used to match patients. Cox proportional hazards models and logistic regression models were constructed to examine associations between revascularization strategies and mortality. Interval Cox models were fitted to estimate time-varying hazards during different periods.
A total of 1,840 propensity score-matched patients receiving dialysis were analyzed. Coronary artery bypass grafting was associated with higher in-hospital mortality (coronary artery bypass grafting vs percutaneous coronary intervention with drug-eluting stent; crude mortality rate 12.5% vs 3.3%; adjusted OR, 5.22; 95% CI, 3.42-7.97; < 0.001) and longer hospitalization duration (median [IQR], 20 [14-30] days vs 3 [2-8] days; < 0.001). After discharge, repeat revascularization, acute coronary syndrome, and repeat hospitalization all occurred more frequently in the percutaneous coronary intervention with drug-eluting stent group. Importantly, with a median follow-up of 2.8 years, coronary artery bypass grafting was significantly associated with a higher risk of all-cause overall mortality (adjusted HR, 1.19; 95% CI, 1.05-1.35; = 0.006) in the multivariable Cox proportional hazard model. Sensitivity and subgroup analyses yielded consistent results.
This was an observational study with mainly Asian ethnicity.
Percutaneous coronary intervention with drug-eluting stent may be associated with better survival than coronary artery bypass grafting in patients receiving dialysis. Future studies are warranted to confirm this finding.
我们旨在研究接受透析的患者中，药物洗脱支架经皮冠状动脉介入治疗与冠状动脉旁路移植术的相对疗效。
这是一项回顾性观察队列研究。
这项基于人群的研究，在台湾国民健康保险研究数据库中，确定了2009年1月1日至2015年12月31日期间因冠状动脉血运重建而住院的接受透析的患者。
患者接受药物洗脱支架经皮冠状动脉介入治疗或冠状动脉旁路移植术。
研究结果为全因死亡率、住院死亡率和再次血运重建。
使用倾向评分对患者进行匹配。构建Cox比例风险模型和逻辑回归模型，以检验血运重建策略与死亡率之间的关联。采用区间Cox模型来估计不同时期的时变风险。
共分析了1840例倾向评分匹配的接受透析的患者。冠状动脉旁路移植术与较高的住院死亡率相关（冠状动脉旁路移植术与药物洗脱支架经皮冠状动脉介入治疗相比；粗死亡率12.5%对3.3%；调整后的比值比为5.22；95%可信区间为3.42 - 7.97；P < 0.001），且住院时间更长（中位数[四分位间距]，20[14 - 30]天对3[2 - 8]天；P < 0.001）。出院后，药物洗脱支架经皮冠状动脉介入治疗组的再次血运重建、急性冠状动脉综合征和再次住院发生率更高。重要的是，在多变量Cox比例风险模型中，中位随访2.8年，冠状动脉旁路移植术与全因总死亡率的较高风险显著相关（调整后的风险比为1.19；95%可信区间为1.05 - 1.35；P = 0.006）。敏感性分析和亚组分析得出了一致的结果。
这是一项主要针对亚洲种族的观察性研究。
在接受透析的患者中，药物洗脱支架经皮冠状动脉介入治疗可能比冠状动脉旁路移植术具有更好的生存率。未来需要进一步研究来证实这一发现。
