Some, but not all, observational studies or subgroup analyses have demon- strated an improved survival rate with revascularization compared with medical therapy in patients with CKD and multivessel CAD,1191,1193,1194 despite the fact that the inci- dence of periprocedural complications (eg, death, MI, stroke, infection, renal failure) is higher in patients with CKD than in those without renal dysfunction. In 2 cohort studies involving patients with a spectrum of kidney disease ranging from mild to severe, adjusted survival was superior for those who underwent bypass surgery compared with those who received only medical therapy.1191,1194 In 1 study, survival after PCI was improved (compared with medical therapy) in patients with mild, moderate, or severe kidney disease but not in those with end-stage kidney disease. The other study yielded opposite results, with longer survival after PCI in patients with end-stage renal disease but not in those with mild, moderate, or severe kidney disease. Some studies have shown that CABG is associated with a greater survival benefit than PCI among patients with severe renal dysfunction.1187 1192,1194 Five studies have suggested that survival is prolonged among patients with CKD after CABG compared with after PCI,1187,1188,1191,1192,1194 whereas 3 other studies indicated that survival is similar after either of the 2 revascularization strategies, regardless of the severity of underlying renal disease.1189,1190,1192 Figure 14. One-year mortality rates in randomized trials of patients with diabetes and multivessel CAD, comparing PCI (experimental) with CABG (control). An OR .1 suggests an advantage of CABG over PCI. 