Comparison of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in NSTEMI Patients with Chronic Kidney Disease

<i>Background and Objectives:</i> Chronic kidney disease (CKD) is frequently observed among patients with non-ST elevation myocardial infarction (NSTEMI) and is associated with increased morbidity and mortality. Evidence comparing long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this high-risk population remains limited. The objective was to compare long-term major adverse cardiac event (MACE) outcomes between PCI and CABG in NSTEMI patients with CKD and multivessel disease. <i>Materials and Methods:</i> A total of 150 consecutive NSTEMI patients with CKD who underwent PCI or CABG were included in this retrospective observational cohort study. Patients were classified as having mild or moderate-to-severe CKD based on eGFR. Long-term outcomes included MACE (death, myocardial infarction, or ischemia-driven revascularization). Kaplan-Meier analysis was used to compare long-term MACE-free survival between groups. <i>Results:</i> PCI (<i>n</i> = 68) and CABG (<i>n</i> = 82) groups demonstrated comparable long-term MACE-free survival (log-rank <i>p</i> = 0.41). One-year MACE-free survival rates were 78% and 82%, respectively. Ischemia-driven revascularization was more frequent after PCI (<i>p</i> = 0.028), whereas major bleeding occurred more commonly after CABG (<i>p</i> = 0.003). <i>Conclusions:</i> In NSTEMI patients with CKD and multivessel disease, PCI and CABG provide comparable long-term MACE-free survival. Despite higher rates of repeat revascularization after PCI and greater bleeding risk after CABG, overall long-term outcomes were similar. CKD severity did not significantly modify treatment-related differences.