TY  - BOOK
AU  - Doenst,Torsten
AU  - Haddad,Haissam
AU  - Stebbins,Amanda
AU  - Hill,James A.
AU  - Velazquez,Eric J.
AU  - Lee,Kerry L.
AU  - Rouleau,Jean L.
AU  - Sopko,George
AU  - Farsky,Pedro S.
AU  - Al-Khalidi,Hussein R.
TI  - Renal Function and Coronary Bypass Surgery in Patients With Ischemic Heart Failure
PY  - 2022///-02
KW  - Text
KW  - local
N1  - /pmc/articles/PMC7541611; /pubmed/32386761
N2  - OBJECTIVE: Chronic kidney disease (CKD) is a known risk factor in cardiovascular (CV) disease but its influence on treatment effect of bypass surgery (CABG) remains unclear. We assessed the influence of CKD on 10-year mortality and CV-outcomes in ischemic HF patients treated with medical therapy (MED) with or without CABG. METHODS: We calculated baseline estimated glomerular filtration rate (eGFR, CKD-EPI formula, CKD stages 1-5) from 1,209 patients randomized to MED or CABG in the Surgical Treatment for IsChemic Heart failure (STICH) trial and assessed its effect on outcome. RESULTS: In the overall STICH cohort, patients in CKD stages 3-5 were older than those in stages 1/2 (66-71 vs. 54-59 years) and had more comorbidities. Multivariable modeling revealed an inverse association between eGFR and risk of death, CV death and/or CV-rehospitalization (all p<0.001, but not for stroke, p=0.697). Baseline characteristics of the two treatment arms were equal for each CKD stage. There were significant improvements in death or CV-rehospitalization with CABG (Stage 1: HR 0.71, CI 0.53-0.96, p=0.02; Stage 2: HR 0.71, CI 0.59-0.84, p<0.0001; Stage 3: HR 0.76, CI 0.53-0.96, p=0.03). These data were inconclusive in stages 4/5 for insufficient patient numbers (N=28). There was no significant interaction of eGFR with the treatment effect of CABG (p=0.25 for death and 0.54 for death or CV-rehospitalization). CONCLUSIONS: Chronic kidney disease is an independent risk factor for mortality in patients with ischemic HF with or without CABG. However, mild to moderate CKD does not appear to influence long-term treatment effects of CABG
UR  - http://dx.doi.org/10.1016/j.jtcvs.2020.02.136
ER  -