Percutaneous Coronary Intervention with a Drug-Eluting Stent Is Associated with Better Survival than Coronary Artery Bypass Grafting in Patients on Peritoneal Dialysis in Taiwan

[[abstract]]Background: The optimal revascularization strategy for coronary artery disease in patients under peritoneal dialysis (PD) is unclear. Recently, we reported that percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) is associated with better survival than coronary artery bypass grafting (CABG) in patients under either hemodialysis or PD. We aim to perform a dedicated subgroup analysis to study the comparative effectiveness in patients under PD. Methods:This retrospective population-based cohort study included PD patients hospitalized for either CABG or PCI with a DES between January 1, 2009, and December 31, 2015, identified in the Taiwan National Health Insurance Research Database. Inverse probability of treatment weighting was used to balance the baseline characteristics. Multivariable logistic regression models and Cox proportional hazard models were used to examine the risks of in-hospital mortality and long-term survival, respectively. Results: From the 4,165 dialysis patients in our cohort, we selected 333 PD patients receiving either CABG (86 patients) or PCI with a DES (247 patients) for analysis. Compared with patients receiving PCI with a DES, the risk of in-hospital mortality was significantly higher in patients receiving CABG [adjusted odds ratio, 5.70; 95% confidence interval (CI) 1.42-22.83; P = 0.014]. The overall mortality was also significantly higher in patients receiving CABG [adjusted hazard ratio, 1.53; 95% CI 1.13-2.08; P = 0.006]. The long-term mortality hazard associated with CABG remained consistent in several sensitivity analyses (Figure 1). Conclusion: CABG was associated with both higher in-hospital and long-term mortality than PCI with a DES in our national cohort of Taiwan PD patients.