Post-Coronary Artery Bypass Medications in Dialysis Patients: Do We Need to Change Strategies?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).
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).
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
Received: 24 May 2019
Accepted: 09 October 2019
31 December 2019 (online)
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