Journal
EUROPEAN JOURNAL OF INTERNAL MEDICINE
Volume 43, Issue -, Pages 28-35Publisher
ELSEVIER
DOI: 10.1016/j.ejim.2017.04.002
Keywords
Coronary artery bypass grafting; Drug-eluting stents; Chronic kidney disease; Coronary artery disease
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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.
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