Author + information
- Gennaro Giustino1,
- Joseph Sabik2,
- Bjorn Redfors3,
- Milan Milojevic4,
- Patrick Serruys5,
- David Kandzari6,
- Marie-Claude Morice7,
- Anthony Gershlick8,
- Philippe Genereux9,
- Ovidiu Dressler3,
- Zixuan Zhang3,
- Roxana Mehran10,
- A. Pieter Kappetein11 and
- Gregg Stone12
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 2Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- 5Imperial College, London, United Kingdom
- 6Piedmont Heart Institute, Atlanta, Georgia, United States
- 7CERC, Massy, France
- 8University of Leicester, Leicester, United Kingdom
- 9Columbia, new york, New York, United States
- 10Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 11Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
The optimal revascularization strategy for pts with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear.
We investigated the outcomes of PCI with everolimus-eluting stents vs CABG in pts with LMCAD disease and low or intermediate SYNTAX scores according to baseline CKD from the multicenter randomized EXCEL trial. CKD was defined as an estimated creatinine clearance (CrCl) <60 mL/min. The primary endpoint was the composite of death, MI, or stroke at 3 years. Event rates were estimated with the Kaplan-Meier method, and hazard ratios (HR) for PCI vs CABG were generated using Cox regression models.
Of 1869 randomized pts with baseline CrCl data, 308 (16.5%) had CKD. Continuously worse baseline renal function was associated with an increasing risk of death, stroke, or MI at 3-year follow-up (Figure). Compared with CABG, PCI was associated with lower rates of in-hospital major adverse events in both CKD and no-CKD patients. At 3 years, there were no significant differences in the rates of death, stroke, or MI between PCI and CABG in pts with CKD (24.3% vs 19.2%; absolute risk difference [ARD] 5.1%; HR 1.23; 95%CI 0.75–2.04) or without CKD (13.4% vs 13.7%; ARD -0.3%; HR 0.94; 95%CI 0.71–1.23) (Pinteraction=0.34).
In the EXCEL trial, worse baseline renal function was associated with an increased risk of adverse events in pts with LMCAD undergoing PCI or CABG. The effect of PCI vs CABG on the 3-year rates of death, stroke, or MI was consistent in pts with and without CKD.
OTHER: Renal Insufficiency and Contrast Nephropathy