CABG still the ‘gold standard’ for revascularization in patients with 3-vessel CAD and CKD.
CABG still the ‘gold standard’ for revascularization in patients with 3-vessel CAD and CKD.
CABG Provides Superior Long-Term Outcomes Compared to PCI in Patients with TVD and CKD
Publication was released by the AHA via its official outlets /February 19, 2025.
A new study published in The American Journal of Cardiology confirms that coronary artery bypass grafting (CABG) offers better long-term outcomes than percutaneous coronary intervention (PCI) in patients with three-vessel coronary artery disease (TVD) and chronic kidney disease (CKD). While mid-term benefits of CABG over PCI were previously established, this study extends the evidence to longer follow-up intervals.
Key Findings:
• Study population: 400+ patients treated between 2009 and 2018 in Alberta, Canada.
• PCI group: 373 patients, mean age: 71 years.
• CABG group: 80 patients, mean age: 65 years.
• Median follow-up: 9.3 years (longest follow-up: 14.1 years).
• Primary outcome: All-cause mortality was significantly lower in the CABG group (68.9%) compared to the PCI group (83.1%).
• Other outcomes at longest follow-up:
• Myocardial infarction readmission: 10.2% (CABG) vs. 28.4% (PCI).
• Repeat revascularization: 3.1% (CABG) vs. 24.4% (PCI).
• Stroke and all-cause rehospitalization rates showed no significant difference between CABG and PCI.
Clinical Implications:
• CABG is expected to become the preferred revascularization strategy for patients with TVD and CKD, given its clear survival benefits.
• The study emphasizes the high morbidity and mortality rates in this population, highlighting the need for perioperative strategies to reduce complications, including renal dysfunction.
• Multidisciplinary heart teams should individualize treatment decisions, as PCI may still be preferable in select cases based on anatomy and patient-specific factors.
• While further research is needed, the study strengthens the case for CABG as the gold standard for revascularization in patients with TVD and CKD.
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