Comparison of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in NSTEMI Patients with Chronic Kidney Disease

TL;DR

This study compares long-term heart outcomes for NSTEMI patients with kidney disease treated with PCI or CABG and finds similar results despite differing risks.

Contribution

The study provides new evidence on long-term outcomes of PCI versus CABG in NSTEMI patients with CKD.

Findings

PCI and CABG showed comparable long-term MACE-free survival in NSTEMI patients with CKD.

PCI had higher repeat revascularization, while CABG had greater bleeding risk.

CKD severity did not significantly affect treatment-related outcome differences.

Abstract

Background and Objectives: Chronic kidney disease (CKD) is frequently observed among patients with non–ST elevation myocardial infarction (NSTEMI) and is associated with increased morbidity and mortality. Evidence comparing long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this high-risk population remains limited. The objective was to compare long-term major adverse cardiac event (MACE) outcomes between PCI and CABG in NSTEMI patients with CKD and multivessel disease. Materials and Methods: A total of 150 consecutive NSTEMI patients with CKD who underwent PCI or CABG were included in this retrospective observational cohort study. Patients were classified as having mild or moderate-to-severe CKD based on eGFR. Long-term outcomes included MACE (death, myocardial infarction, or ischemia-driven revascularization). Kaplan–Meier analysis was used to compare long-term MACE-free survival between groups. Results: PCI (n = 68) and CABG (n = 82) groups demonstrated comparable long-term MACE-free survival (log-rank p = 0.41). One-year MACE-free survival rates were 78% and 82%, respectively. Ischemia-driven revascularization was more frequent after PCI (p = 0.028), whereas major bleeding occurred more commonly after CABG (p = 0.003). Conclusions: In NSTEMI patients with CKD and multivessel disease, PCI and CABG provide comparable long-term MACE-free survival. Despite higher rates of repeat revascularization after PCI and greater bleeding risk after CABG, overall long-term outcomes were similar. CKD severity did not significantly modify treatment-related differences.

Figures