Journal
FRONTIERS IN CARDIOVASCULAR MEDICINE
Volume 8, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fcvm.2021.818958
Keywords
meta-analysis; revascularization; conservative medical treatment; coronary artery disease; chronic kidney disease
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Funding
- Sichuan Science and Technology Program (Sichuan, China) [2021YFS0330]
- 1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (Sichuan, China) [2021HXFH061]
- Sichuan University [20826041E4070]
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Revascularization is more effective in reducing mortality than medical treatment alone in patients with CKD and CAD. This benefit is consistent in patients with stable CAD and elderly patients. However, future randomized controlled trials are required to confirm these findings.
Background:& nbsp;As a strong risk factor for coronary artery disease (CAD), chronic kidney disease (CKD) indicates higher mortality in patients with CAD. However, the optimal treatment for the patients with two coexisting diseases is still not well defined.Methods:& nbsp;To conduct a meta-analysis, PubMed, Embase, and the Cochrane database were searched for studies comparing medical treatment (MT) and revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] in adults with CAD and CKD. Long-term all-cause mortality was evaluated, and subgroup analyses were performed.Results:& nbsp;A total of 13 trials met our selection criteria. Long-term (with at least a 1-year follow-up) mortality was significantly lower in the revascularization arm [relative risk (RR) = 0.66; 95% CI = 0.60-0.72] by either PCI (RR = 0.61; 95% CI = 0.55-0.68) or CABG (RR = 0.62; 95% CI = 0.46-0.84). The results were consistent in dialysis patients (RR = 0.68; 95% CI = 0.59-0.79), patients with stable CAD (RR = 0.75; 95% CI = 0.61-0.92), patients with acute coronary syndrome (RR = 0.62; 95% CI = 0.58-0.66), and geriatric patients (RR = 0.57; 95% CI = 0.54-0.61).Conclusion:& nbsp;In patients with CKD and CAD, revascularization is more effective in reducing mortality than MT alone. This observed benefit is consistent in patients with stable CAD and elderly patients. However, future randomized controlled trials (RCTs) are required to confirm these findings.
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