Thorac Cardiovasc Surg 2020; 68(08): 706-713
DOI: 10.1055/s-0039-3400471
Original Cardiovascular

Post-Coronary Artery Bypass Medications in Dialysis Patients: Do We Need to Change Strategies?

Yu-Ning Hu
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
,
Chwan-Yau Luo
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
,
Meng-Ta Tsai
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
,
Ting-Wei Lin
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
,
Chung-Dann Kan
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
,
Jun-Neng Roan
1  Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
2  Medical Device Innovation Center, National Cheng Kung University College of Medicine, Tainan, Taiwan
3  Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
› Author Affiliations
Funding National Cheng Kung University Hospital (Grant/Award Number: “NCKUH-10803027” to YNH) and National Science Institute (Grant/Award Number: “MOST 108–2314-B-006–097” to JNR).

Abstract

Background Coronary artery bypass grafting (CABG) is frequently performed in patients with end-stage renal disease (ESRD) together with severe coronary artery disease, after which, patients with ESRD have higher surgical risk and poorer long-term outcomes. We report our experience in patients with ESRD who survived in CABG and identify predictors of long-term outcomes.

Methods We retrospectively investigated 93 consecutive patients with ESRD who survived to discharge after isolated CABG between January 2005 and December 2016 at our institution. Long-term outcomes, including all-cause mortality after discharge, readmission due to major adverse cardiac events, and reintervention, were evaluated. Predictors affecting long-term outcomes were also analyzed.

Results The rates of freedom from all-cause mortality after discharge in 1, 3, 5, and 10 years were 92.1, 81.3, 71.9, and 34.9%, respectively. The rates of freedom from readmission due to major adverse cardiac events in 1, 3, 5, and 10 years were 90.7, 79.1, 69.9, and 55.6%, respectively. The rates of freedom from reintervention in 1, 3, 5, and 10 years were 95.3, 86.5, 79.0, and 66.6%, respectively. Postoperative β-blocker and statin use significantly improved overall long-term survival (β-blocker, p = 0.013; statin, p = 0.009). After case–control matching, patients who received statins showed better long-term survival than those without statins. The comparison of long-term survival between patients with and without β-blockers showed no significant difference after matching.

Conclusions After CABG, dialysis patients who survived to discharge had acceptable long-term overall survival. Post-CABG statin use in dialysis patients is a predictor of better long-term survival.

Statement of Ethics

The hospital's Institutional Review Board approved the study (IRB: A-ER-107–171).


Disclosure Statement

None declared.


Authors' Contributions

Conception and design of study: Chwan-Yau Luo, Jun-Neng Roan


Acquisition of data: Yu-Ning Hu, Ting-Wei Lin


Analysis and/or interpretation of data: Yu-Ning Hu, Chung-Dann Kan


Drafting the manuscript: Yu-Ning Hu


Revising the manuscript: Meng-Ta Tsai, Jun-Neng Roan


Approval of the version of the manuscript: Chwan-Yau Luo, Jun-Neng Roan




Publication History

Received: 24 May 2019

Accepted: 09 October 2019

Publication Date:
31 December 2019 (online)

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