Percutaneous coronary intervention with drug-eluting stent is associated with better survival than coronary artery bypass grafting in Taiwan dialysis patients

Rationale and Objective: To study the comparative effectiveness of percutaneous coronary intervention with drug-eluting stent and coronary artery bypass grafting in dialysis patients. Study Design: Retrospective observational cohort study. Setting and Participants: This population-based study identified dialysis patients hospitalized for coronary revascularization between January 1, 2009 and December 31, 2015 in Taiwan National Health Insurance Research Database. Exposures: Percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting. Outcomes: All-cause mortality, in-hospital mortality, and repeat revascularization. Analytical Approach: Propensity scores were used to match patients. Cox proportional hazards models and logistic regression models were constructed to examine associations between revascularization strategies and mortality. Interval Cox models were fit to estimate time-varying hazards during different periods. Results: A total of 1,840 propensity score-matched dialysis patients were analyzed. Coronary artery bypass grafting was associated with higher in-hospital mortality (coronary artery bypass grafting vs. percutaneous coronary intervention with drug-eluting stent, crude mortality rate 12.5% vs. 3.3%; adjusted odds ratio 5.22; 95% confidence interval [CI] 3.42-7.97; p < 0.001), and longer hospitalization duration (median [interquartile range], 20 [14-30] days vs. 3 [2-8] days, p < 0.001). After discharge, repeat revascularization, acute coronary syndrome, and repeat hospitalization all occurred more frequently in the percutaneous coronary intervention with drug-eluting stent group. Importantly, with a median follow-up of 2.8 years, coronary artery bypass grafting was significantly associated with a higher risk of all-cause overall mortality (adjusted hazard ratio 1.19, 95% CI 1.05-1.35, p < 0.01) in the multivariable Cox proportional hazard model. Sensitivity and subgroup analyses yielded consistent results. Limitations: Observational study with mainly Asian ethnicity. Conclusions: Percutaneous coronary intervention with drug-eluting stent may be associated with better survival than coronary artery bypass grafting in dialysis patients. Future studies are warranted to confirm this finding. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Szu-Yu Pan was supported by the Ministry of Science and Technology (MOST) (106-2314-B-418-006, 107-2314-B-418-001, 108-2314-B-418-004, and 110-2314-B-418-002). Likwang Chen was supported by the Ministry of Science and Technology (MOST) (106-2314-B-400 -015 -) and intramural funding from the National Health Research Institutes, Taiwan. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This retrospective cohort study was approved by the Institutional Review Board of National Health Research Institutes, Taiwan (EC1060402-E). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The access to National Health Insurance (NHI) Research Database in Taiwan requires application and approval by Taiwan NHI Administration.