Perspective:

These data from a large sample of dialysis patients demonstrate the tradeoffs pertinent to clinical decisions on the optimal revascularization strategy in this high-risk population: high in-hospital mortality rates, but superior long-term survival (especially with use of internal mammary grafts) with surgical revascularization and better short-term survival, but higher probability of repeat revascularization with PCI using BMS and DES. For some patients, PCI with DES might be preferable because the higher perioperative mortality (and likely morbidity) of CABG might be a less acceptable choice, despite potentially superior long-term survival. These findings also highlight the importance of a heart team approach (i.e., deriving input from interventional cardiologists and cardiovascular surgeons to determine an individualized, optimal approach) for coronary revascularization for each individual patient.