Coronary revascularization improves long-term prognosis in diabetic and nondiabetic end-stage renal disease

To test the hypothesis that coronary revascularization improves long-term prognosis in patients with hemodialysis, 80 of 121 patients (66%) on maintenance hemodialysis who had undergone initial coronary angiography had bypass surgery, catheter angioplasty, or both between 1983 and 1999. Multivessel disease was more frequent (p=0.01) and the duration of hemodialysis therapy was shorter (p=0.01) in patients with diabetes (n=61), than in nondiabetic patients (n=60). Of the patients who underwent revascularization, complete revascularization was achieved in 75% of those with diabetic nephropathy (30/40) and 83% in a similar number of nondiabetic patients (33/40). The 5-year survival rate from initiation of hemodialysis was 79% in diabetic and 96% in non-diabetic patients (p<0.01), exceeding published Japanese (53% vs 70%) and US (26% vs 60%) survival rates. When survival was studied from the date of revascularization, predictors of outcome were age and achievement of complete revascularization. Surprisingly, diabetes was not a predictor of survival outcome. Complete revascularization improves long-term survival in both diabetic and nondiabetic patients.