Arterial Grafting Survival Benefit in Patients With End-Stage Renal Disease Undergoing Coronary Artery Bypass Grafting.

Abstract

End-stage renal disease (ESRD) is associated with increased morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG); however, the survival benefit of arterial grafting in this population remains unclear. Given the dramatic impact that transplantation can have on long-term survival in patients with ESRD, this study compared hospital and long-term survival for arterial graft vs saphenous vein graft (SVG) only in patients with ESRD who did or did not undergo transplantation. With use of the United States Renal Data System, data were collected on all isolated CABG patients along with subsequent transplant status from 2015 to 2021. CABG patterns were divided as left internal mammary artery (LIMA) plus SVG, SVG only, and multiarterial grafting (MAG). Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. In total, there were 14,917 (89.8%) patients in LIMA, 512 (3.1%) patients in MAG, and 1187 (7.1%) patients in SVG only. After IPTW, comparison groups were well balanced. In IPTW-adjusted cohorts, LIMA showed a 5-year survival benefit compared with SVG only in patients not receiving transplants (31.6% vs 26.6%; P < .001); however, in landmark analysis, this difference diminished after 4 years. MAG grafting did not show a 5-year survival benefit over LIMA in either patients who did not undergo transplantation (31.7% vs 31.6%; P = .21) or patients who received transplants (80.5% vs 84.8%; P = .65). Despite diminished life expectancy for patients with ESRD, there remains an early survival benefit for LIMA grafting in patients who do not undergo transplantation. Limited data did not demonstrate a significant survival benefit for MAG vs LIMA in patients with ESRD regardless of subsequent transplantation status.