Retrospective comparative study of &nbsp;the short and long term outcomes of primary coronary intervention(PCI)vs coronary artery bypass graft (CABG) in chronic kidney disease (CKD) population. The outcomes include deaths, recurrence of acute coronary syndrome (ACS), bleeding complication, heart failure and hemodialysis dependence after the procedure
Authors: Arachchi Gayani Nadeesha Wickrama , Herath Chula , Ahmed Shiyam , Manjika Sithum 
Published: March 2021

Abstract
BackgroundOccurrence of cardiovascular disease and deaths is more in patients with chronic kidney disease. For patients with Chronic kidney disease (CKD) and multivessel coronary artery disease (CAD), the optimal revascularization study is still debatable. This is a single center retrospective study to compare the short- and long-term outcomes of PCI vs CABG in CKD patients who presented with in Sri Lanka. The study was aimed to compare the outcomes of PCI vs CABG in cohort of CKD patients in Sri Lanka who presented with acute coronary syndrome.MethodsA retrospective comparative study was conducted at Sri Jayawardenapura General Hospital on patients with CKD who underwent CABG and PCI since 2013 to 2017. Patients with CKD who underwent PCI, the outcomes were matched to patients who underwent CABG for multivessel disease by using univariate and multivariate statistical analysis methods. The outcomes include deaths, recurrence of acute coronary syndrome, LV dysfunction, bleeding complications and stroke. Data were obtained from past medical records, clinic records and telephone interviews.ResultsThere were 423 patients met inclusion criteria with mean age 59.94 ± 8.381 years. There were 81.3%(n = 344) of males. The prevalence of Diabetes, hypertension, dyslipidemia in the study sample was 89.2%(n = 363),83.3%(n = 339), and 34.9% (n = 142) respectively. The prevalence of CKD stage I and II ,111,1V and V was 38%(n = 165), 36.9% (n = 156),12.5%(n = 54),11.3%(n = 48) respectively. The recurrence of ACS in PCI group was 14.3%(n = 34),23.6%(n = 56),12.7%(n = 30) compared to CABG group 7.5%(n = 14),7%(n = 13),0% in 1 month, 1 year and 3 years’ time (X2 = 4.817, p < 0.05, X2 = 21.136, P < 0.01, P < 0.05). There was a statistically significant reduction in recurrences of ACS in CABG group compared to PCI group in CKD population. The incidence of LV dysfunction in the PCI group was 24%(n = 18)50.7%(n = 38),29.3%(n = 22) compared to CABG group 80%(n = 12),20%(n = 3),0% in 1 month,1 year and 3 years (p < 0.05 using fishers exact test). There was a significant reduced occurrence of LV dysfunction in CABG group compared to PCI group in 1 year and 3 years’ time.ConclusionIn conclusion, most of the CKD population with acute coronary syndrome were males with younger age group. Also, most of them had associated risk factors include hypertension, diabetes mellitus and dyslipidemia. The CKD population had presented with acute coronary syndrome at relative younger age might be due to associated risk factors. There was no difference in mortality rate between CABG vs PCI in CKD population. However, there was a significant reduction in recurrence of acute coronary syndrome, LV dysfunction, bleeding complications and stroke in CABG group than PCI group in CKD population. There was no significant association of end up in dialysis following PCI or CABG.