Comparative Effectiveness Analysis of Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease and Unprotected Left Main Coronary Artery Disease Insights from a Large-Sized All-Comers Registry

AIMS: 

Outcomes according to the status of renal insufficiency were not fully evaluated in left main coronary artery disease (LMCAD). 

METHODS AND RESULTS: 

Among 4894 patients with LMCAD, renal insufficiency was graded according to the estimated glomerular filtration rate (eGFR). The primary outcome was major adverse cardiocerebrovascular event (MACCE), defined as death, myocardial infarction, stroke, or any revascularization. 3,824 (78%) had group 1 (eGFR ≥60 ml·min -1·1.73m2), 838 (17%) had group 2 (eGFR ≥ 30 and <60), and 232 (5%) had group 3 (eGFR <30). At 2 years, after adjustment, compared with group 1, the risk of MACCE was significantly higher in group 2 (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.18-1.79) and in group 3 (HR 3.39, 95% CI 2.61-4.40). Meanwhile, the P interaction for MACCE across groups was 0.20. The adjusted risk of MACCE was similar between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in group 1 or 2. However, PCI was associated with a significantly higher risk of MACCE compared to CABG (HR 1.88, 95% CI 1.08-3.25) in group 3. 

CONCLUSIONS: 

The degree of renal insufficiency was proportionately associated with unfavorable outcomes in patients with LMCAD. In group 3, PCI was associated with a higher risk of MACCE compared with CABG. Also, the effect of PCI vs. CABG on MACCE was consistent, with PCI being associated less bleeding and CABG being associated with less repeat revascularization.