For patients with end-stage renal disease (ESRD) on dialysis who also must be treated for heart disease, stents provide the best one-year survival compared with other revascularization treatments, but bypass surgery provides the best long-term survival, according to a study presented Nov. 6 at the American Society of Nephrology's 41st annual meeting and scientific exposition in Philadelphia.
Despite the widespread use of the therapies, it is unclear which is best for treating patients with coronary artery disease, let alone heart disease patients who also have kidney disease. Charles Herzog, MD, and Craig Solid of the Cardiovascular Special Studies Center at the U.S. Renal Data System (USRDS) in Minneapolis, Minn., compared the survival of dialysis patients undergoing the different revascularization procedures.
The investigators analyzed information housed in the USRDS database, where they found data on 13,066 dialysis patients treated with coronary bypass surgery, non-drug-eluting stents (DES), or DES from 2003-2005. These were patients undergoing their first coronary revascularization procedure after developing advanced kidney disease. There were 3,665 patients receiving coronary bypass surgery, 6,164 receiving DES and 3,237 receiving non-DES
The researchers found that DES were associated with the best one-year survival, but long-term survival was best in patients who received bypass surgery. The survival advantage of surgery was increased with greater numbers of arteries bypassed.
This study suggests that there is not a simple answer to the question of which revascularization procedure is best in dialysis patients. "It is conceivable that different patients might view this information, when presented to them by their counseling physician regarding treatment options, in different ways,” Herzog said.
For example, the authors wrote that if patients wish to maximize their chance of a better short-term result with fewer in-hospital risks, they may choose DES. On the other hand, some patients may choose to maximize their long-term survival while risking higher in-hospital complications and worse short-term survival.