Optimized medical therapy vs. percutaneous revascularization vs. surgical coronary revascularization for coronary disease in CKD

A new study compared medical therapy, surgical coronary revascularization (CABG), and percutaneous revascularization (PCI) in Medicare-eligible patients with CKD. CABG and PCI were not associated with improved survival in low-risk patients, whereas CABG appeared to be associated with greater risk for the composite outcome of death or kidney failure. In contrast, both CABG and PCI were associated with improved survival compared with medical therapy in high-risk patients with acute coronary syndrome (ACS), but CABG was also associated with greater risk for kidney failure. These findings suggest that revascularization is not always the best treatment for coronary disease in patients with CKD and may help clinicians weighing pragmatic issues regarding treatment of ischemic heart disease in patients with CKD who do not require renal replacement therapy.

Read the paper here