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Comparison of coronary artery bypass grafting and drug-eluting stents in patients with chronic kidney disease and multivessel disease: A meta-analysis

Published:April 08, 2017DOI:https://doi.org/10.1016/j.ejim.2017.04.002

      Highlights

      • A meta-analysis of CABG versus PCI-DES in patients with CKD.
      • A total of 11 studies with 29,246 patients were included.
      • CABG had advantages over DES in long-term mortality and myocardial infarction.
      • DES had lower short-term mortality and cerebrovascular accident compared with CABG.

      Abstract

      Background

      The optimal revascularization strategy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD) and multivessel disease (MVD) remains unclear.

      Methods

      Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception until June 2016. Studies that evaluate the comparative benefits of DES versus CABG in CKD patients with multi-vessel disease were considered for inclusion. We pooled the odds ratios from individual studies and conducted heterogeneity, quality assessment and publication bias analyses.

      Results

      A total of 11 studies with 29,246 patients were included (17,928 DES patients; 11,318 CABG). Compared with CABG, pooled analysis of studies showed DES had higher long-term all-cause mortality (OR, 1.22; p < 0.00001), cardiac mortality (OR, 1.29; p < 0.00001), myocardial infarction (OR, 1.89; p = 0.02), repeat revascularization (OR, 3.47; p < 0.00001) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p = 0.002), but lower short-term all-cause mortality (OR, 0.33; p < 0.00001) and cerebrovascular accident (OR, 0.64; p = 0.0001). Subgroup analysis restricted to patients with end-stage renal disease (ESRD) yielded similar results, but no significant differences were found regarding CVA and MACCE.

      Conclusions

      CABG for patients with CKD and MVD had advantages over PCI-DES in long-term all-cause mortality, MI, repeat revascularization and MACCE, but the substantial disadvantage in short-term mortality and CVA. Future large randomized controlled trials are certainly needed to confirm these findings.

      Keywords

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