Comparison of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in NSTEMI Patients with Chronic Kidney Disease.

Background and

Objectives

Chronic kidney disease (CKD) is frequently observed among patients with non-ST elevation myocardial infarction (NSTEMI) and is associated with increased morbidity and mortality. Evidence comparing long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this high-risk population remains limited. The objective was to compare long-term major adverse cardiac event (MACE) outcomes between PCI and CABG in NSTEMI patients with CKD and multivessel disease. Materials and

Methods

A total of 150 consecutive NSTEMI patients with CKD who underwent PCI or CABG were included in this retrospective observational cohort study. Patients were classified as having mild or moderate-to-severe CKD based on eGFR. Long-term outcomes included MACE (death, myocardial infarction, or ischemia-driven revascularization). Kaplan-Meier analysis was used to compare long-term MACE-free survival between groups.

Results

PCI (n = 68) and CABG (n = 82) groups demonstrated comparable long-term MACE-free survival (log-rank p = 0.41). One-year MACE-free survival rates were 78% and 82%, respectively. Ischemia-driven revascularization was more frequent after PCI (p = 0.028), whereas major bleeding occurred more commonly after CABG (p = 0.003).

Conclusions

In NSTEMI patients with CKD and multivessel disease, PCI and CABG provide comparable long-term MACE-free survival. Despite higher rates of repeat revascularization after PCI and greater bleeding risk after CABG, overall long-term outcomes were similar. CKD severity did not significantly modify treatment-related differences.