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

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) andmajor adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p = 0.002), but lower short-termall-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-termall-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. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.