Key result
Hemodialysis in patients undergoing CABG was associated with higher hospital mortality (4.9% vs 1.0%) and cardiac death (P=0.018), but similar deaths due to ischemic heart disease (P=0.327).
Why the study?
Does CABG with complete revascularization provide equivalent long-term prevention of ischemic cardiac events in patients on hemodialysis compared to those not on hemodialysis?
Cohort (n=746)
Does CABG with complete revascularization provide equivalent long-term prevention of ischemic cardiac events in patients on hemodialysis compared to those not on hemodialysis?
CABG with complete revascularization provides equivalent long-term prevention of ischemic cardiac events in hemodialysis patients compared to non-hemodialysis patients, despite a higher overall cardiac mortality driven by non-ischemic causes.
Answers are grounded in this paper and cite their sources.
Excess cardiac mortality after CABG in hemodialysis is non-ischemic; leaves open whether complete revascularization equally prevents long-term ischemic events.
Background: Patients on hemodialysis are at high risk of adverse cardiac events after coronary artery bypass grafting (CABG). The aim of this study is to know whether CABG with complete revascularization and similar graft selection can provide equivalent long-term benefits for patients on and not on hemodialysis. Methods: Between 2004 and 2018, 746 patients underwent isolated CABG, of which 106 were on hemodialysis. Propensity matching on baseline characteristics, graft types and on/off-pump CABG was performed to compare clinical outcomes between patients on (n = 102) and not on (n = 102) hemodialysis. Results: Complete revascularization was achieved in all patients. The mean follow-up was 112.5 ± 46.6 months. Off-pump rates (hemodialysis vs non-hemodialysis, 93/102 vs 94/102, p > 0.999) and graft selections (distal anastomoses: 3.7 ± 1.4 vs 3.8 ± 1.5, p = 0.377, ITA grafts: 1.4 ± 0.6 vs 1.5 ± 0.6, p = 0.560, arterial grafts: 1.9 ± 0.9 vs 2.0 ± 0.8, p = 0.658, vein grafts: 0.69 ± 0.63 vs 0.65 ± 0.70, p = 0.513) were well balanced between the groups. Hospital mortality was higher in patients on hemodialysis than in those not on hemodialysis (5/102 vs 1/102, p = 0.212). The Kaplan-Meier analysis revealed that cardiac death (without non-cardiac causes) was significantly more common in patients on hemodialysis than in those not on hemodialysis (p = 0.018). However, there were no significant differences in deaths due to ischemic heart disease (p = 0.327), repeated revascularization (p = 0.542), myocardial infarction (p = 0.783), and heart failure requiring admission (p = 0.371). Conclusion: CABG with complete revascularization and similar graft selection provides equivalent long-term benefits with regard to the prevention of adverse cardiac events due to ischemic heart disease in patients on and not on hemodialysis.
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Imura et al. (2018) conducted a cohort in Coronary artery disease requiring CABG (n=746). Hemodialysis vs. Not on hemodialysis was evaluated on Deaths due to ischemic heart disease (p=0.327). Hemodialysis in patients undergoing CABG was associated with higher hospital mortality (4.9% vs 1.0%) and cardiac death (P=0.018), but similar deaths due to ischemic heart disease (P=0.327).
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