Background: Patients with chronic kidney disease (CKD) are generally considered at an increased risk for cardiovascular events. The aim of the present study was to compare outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with eGRF under 45 ml/min/m2.

Methods: This is a retrospective study which enrolled 110 patients with coronary artery disease (CAD) undergoing PCI and 148 patients with (CAD) undergoing isolated CABG in 2007-2010. All patients had from stage ≥3b chronic kidney diseases (eGFR < 45 ml/min/m2).

Results: Overall survival in CABG patients was 51.2 (±2.5) months and 41.5 (± 2.7) months in PCI patients (P=0.07). When stratified according to eGFR (under and over 30 ml/min/m2) survival was better for CABG (Log rank p=0.043). Overall freedom from major adverse cardiac and cerebrovascular events (MACCE) was 65% after CABG and 28% after PCI (p=0.042). On Cox regression PCI was an independent predictor of overall mortality (HR 1.74, 95% CI 1.08-2.78) and cardiac mortality (HR 2.01, 95% CI 1.13-3.56).

Conclusion: Patients with CKD have a high rate of mortality and morbidity after PCI and CABG. However, it seems that in the long term, patients with severe renal dysfunction (eGRF < 30 ml/min/ m2) might benefit from surgical revascularization. Therefore, patients with severe renal impairment need to be viewed as candidates for CABG when considering different treatment options.