Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial.
Eduardo Gomes Lima,David M. Charytan,Whady Hueb,D F C Azevedo,Cibele Larrosa Garzillo,Desiderio Favarato,Jaime Paula Pessoa Linhares Filho,E B Martins,Daniel Valente Batista,Paulo Cury Rezende,Alexandre Ciappina Hueb,José Antonio Franchini Ramires,Roberto Kalil Filho +12 more
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Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up, and more study is needed to confirm these benefits in moderate CKD.Abstract:
Background Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Methods Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (≥90, 89-60 and 59-30 mL/min/1.73 m2, respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com. Registration number: ISRCTN66068876). Results Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07-0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31-0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25-0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07-4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. Conclusions Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.read more
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Impact of preprocedural biological markers on 10-year mortality in the SYNTAXES trial
TL;DR: In this paper , the impact of preprocedural biological markers on 10-year mortality following coronary revascularization was investigated, and the associations between mortality and pre-cedural C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides, low-density lipoprotein cholesterol, and high-density lipid cholesterol were analyzed.
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Revascularization vs. Conservative Medical Treatment in Patients With Chronic Kidney Disease and Coronary Artery Disease: A Meta-Analysis
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TL;DR: In this paper, the relative role of coronary artery bypass grafting and percutaneous coronary intervention with stent implantation in patients with chronic kidney disease (CKD) and complex...
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Yuan Fu,Hao Sun,Zongsheng Guo,Li Xu,Xinchun Yang,Lefeng Wang,Kuibao Li,Mulei Chen,Yuanfeng Gao +8 more
TL;DR: A novel RS model, which was established to help predict in-hospital mortality of patients with ESRD and AMI, was easy to use and had higher accuracy than the GRACE RS.
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Impact of eGFR rate on 1-year all-cause mortality in patients with stable coronary artery disease.
Leonardo De Luca,Francesca Cappadona,Pier Luigi Temporelli,Lucio Gonzini,A Ledda,Arturo Raisaro,Francesca Viazzi,Domenico Gabrielli,Furio Colivicchi,Michele Massimo Gulizia,Roberto Pontremoli +10 more
TL;DR: In this article , the prevalence of different degree of estimated glomerular filtration rate (eGFR) reduction, the clinical and bio-humoral correlates, its relationship with therapeutic management, and its predictive role on 1-year all-cause mortality, in patients with stable coronary artery disease (CAD) was investigated.
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Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS II) A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
Whady Hueb,Neuza Lopes,Bernard J. Gersh,Paulo R. Soares,Luiz Antônio Machado,Fabio Biscegli Jatene,Sérgio Almeida de Oliveira,José Antonio Franchini Ramires +7 more
TL;DR: CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction at the 5-year follow-up of patients with stable multivessel coronary artery disease, and was associated with an incidence of long-term events and rate of additional revascularization similar to those for PCI.
Journal ArticleDOI
Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease
Kaare H. Bønaa,Jan Mannsverk,Rune Wiseth,Lars Aaberge,Yngvar Myreng,Ottar Nygård,Dennis W.T. Nilsen,Nils-Einar Kløw,Michael Uchto,Thor Trovik,Bjørn Bendz,Sindre Stavnes,Reidar Bjørnerheim,A.I Larsen,Morten Slette,Terje K. Steigen,Ole J Jakobsen,Øyvind Bleie,Eigil Fossum,Tove Aminda Hanssen,Øystein Dahl-Eriksen,Inger Njølstad,Knut Rasmussen,Tom Wilsgaard,Jan Erik Nordrehaug,Norstent Investigators +25 more
TL;DR: In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction.
Journal ArticleDOI
Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II)
Whady Hueb,Neuza Lopes,Bernard J. Gersh,Paulo R. Soares,Expedito E. Ribeiro,Alexandre C. Pereira,Desiderio Favarato,Antonio Sérgio C. Rocha,Alexandre Ciappina Hueb,José Antonio Franchini Ramires +9 more
TL;DR: In this article, the authors compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function.