Percutaneous coronary intervention has better in-hospital outcomes in severe renal failure patients

BackgroundIn patients with severe renal failure, coronary artery bypass surgery (CABG) was found to have better long-term outcomes than percutaneous coronary intervention (PCI). This study aims to provide a retrospective analysis of short-term in-hospital peri-operative outcomes between PCI and CABG in patients with severe renal failure. MethodsPatients who underwent CABG and PCI in Q4 2015-2020 were identified in National Inpatient Sample (NIS) database. Patients of age<40 were excluded for congenital heart defects. Patients with comorbidity of severe renal failure were included. Between patients undergoing PCI and CABG, preoperative variables were compared and corrected in multivariable logistic regression examining their in-hospital peri-operative outcomes. Adjusted odds ratios (aOR) were estimated for mortality and morbidities. ResultsIn NIS, 4,512 CABG and 13,242 PCI cases were identified. Compared to CABG, patients who underwent PCI had lower mortality (4.24% vs 5.47%, aOR 0.725, p<0.0001) and lower morbidity including heart failure (0.14% vs 2.97%, aOR 0.044, p<0.0001), stroke (0.12% vs 0.47%, aOR 0.264, p<0.0001), respiratory complications (0.51% vs 7.34%, aOR 0.063, p<0.0001), renal complications (0.05% vs 0.49%, aOR 0.075, p<0.0001), acute kidney injury (8.67% vs 12.66%, aOR 0.646, p<0.0001), deep wound complications (0.02% vs 0.35%, aOR 0.042, p < 0.0001), shock (0.22% vs 0.95%, aOR 0.228, p<0.0001), and length of in-hospital stay over 7 days (24.75% vs 73.52%, aOR 0.106, p<0.0001). ConclusionNIS is a comprehensive database of nationwide providers, providing robust power in analysis. In patients with severe renal failure, PCI offers an advantage over CABG in terms of short-term in-hospital perioperative outcomes.