o:3228 Left main revascularization with PCI or CABG in patients with chronic kidney disease en BACKGROUND: The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. OBJECTIVES: This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase $5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. RESULTS: CKD was present in 361 of 1,869 randomized patients (19.3%) in whom baseline estimated glomerular filtration rate was available. Patients with CKD had higher 3-year rates of the primary endpoint compared with those without CKD (20.8% vs. 13.5%; hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 1.22 to 2.09; p 1⁄4 0.0005). ARF within 30 days occurred more commonly in patients with compared with those without CKD (5.0% vs. 0.8%; p < 0.0001), and was strongly associated with the 3-year risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95% CI: 2.73 to 7.73; p < 0.0001). ARF occurred less commonly after revascularization with PCI compared with CABG both in patients with CKD (2.3% vs. 7.7%; HR: 0.28; 95% CI: 0.09 to 0.87) and in those without CKD (0.3% vs. 1.3%; HR: 0.20; 95% CI: 0.04 to 0.90; pinteraction 1⁄4 0.71). There were no significant differences in the rates of the primary composite endpoint after PCI and CABG in patients with CKD (23.4% vs. 18.1%; HR: 1.25; 95% CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%; HR: 0.97; 95% CI: 0.73 to 1.27; pinteraction 1⁄4 0.38). CONCLUSIONS: Patients with CKD undergoing revascularization for LMCAD in the EXCEL trial had increased rates of ARF and reduced event-free survival. ARF occurred less frequently after PCI compared with CABG. There were no sig- nificant differences between PCI and CABG in terms of death, stroke, or MI at 3 years in patients with and without CKD. Appendix: https://unilib.phaidrabg.rs/o:3229 Key words: chronic kidney disease, coronary artery bypass grafting, coronary artery disease, left main, percutaneous coronary intervention 91552100 128335369 1552101 0735-1097 1552099 10.1016/j.jacc.2018.05.057 2023-11-14T21:13:18.769Z 44 yes 46 Gennaro Guistino 106215177 2018 46 Roxana Mehran 46 Patrick W. Serruys 46 Joseph F. Sabik III 46 Milan Milojević 106163721 0000-0003-0984-9011 2018 46 Charles A. Simonton 46 John D. Puskas 46 David E. Kandzari 46 Marie-Claude Morice 46 David P. Taggart 46 Anthony H. Gershlick 46 Philippe Généreux 46 Zixuan Zhang 46 Thomas McAndrew 46 Björn Redfors 46 Michael Ragosta III 46 Irving L. Kron 46 Ovidiu Dressler 46 Martin B. Leon 46 Stuart J. Pocock 46 Ori Ben-Yehuda 46 Arie Pieter Kappetein 46 Gregg W. Stone application/pdf 1349260 https://unilib.phaidrabg.rs/o:3228 no yes 1 70 616.132-089:616.61 92000001 71A11 Journal of the American College of Cardiology 72 7 754 765 2018