BackgroundAs 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.MethodsTo 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.ResultsA 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).ConclusionIn 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.

No abstract

Background: Total arterial revascularization (TAR) has gradually become accepted and recognized, but its effect and safety in diabetic patients are not clear. We performed a systematic review and meta-analysis to summarize the safety and efficacy of TAR and additionally evaluated the clinical outcomes of arterial revascularization using different arterial deployments in patients with diabetes. Methods: PubMed, Embase, and the Cochrane Library databases from inception to July 2022 for studies that studied the effect of arterial revascularization in diabetic patients undergoing isolated coronary artery bypass graft (CABG) were searched. The primary outcome was long-term ( 12 months of follow-up) death by any cause. The secondary efficacy endpoints were long-term ( 12 months) cardiovascular death, early sternal wound infection (SWI) and death ( 30 days or in hospital). Risk ratios (RRs), hazard ratios (HRs), and their corresponding 95% confidence intervals (CIs) were calculated to describe short-term results and long-term survival outcomes. Two different ways were used to analyze the effect of TAR and the impact of diabetes on the clinical outcomes of TAR. Results: Thirty-five studies were included in the study, covering 178,274 diabetic patients. Compared to conventional surgery with saphenous veins, TAR was not associated with increased early mortality (RR 0.77, 95% CI 0.48–1.23) and risk of SWI (RR 0.77, 95% CI 0.46–1.28). The overall Kaplan–Meier survival curves based on reconstructed patient data indicated a significant association between TAR and reduced late mortality (HR 0.52, 95% CI 0.48–0.67) and the curves based on the propensity-score matched (PSM) analyses suggested a similar result (HR 0.74, 95% CI 0.66–0.85). TAR could also effectively decrease the risk of cardiovascular death (HR 0.42, 95% CI 0.24–0.75). Through comparing the effect of TAR in patients with and without diabetes, we found that the presence of diabetes did not elevate the risk of early adverse events (death: RR 1.50, 95% CI 0.64–3.49; SWI: RR 2.52, 95% CI 0.91–7.00). Although diabetes increased long-term mortality (HR 1.06; 95% CI 1.35–2.03), the cardiovascular death rate was similar in patients with diabetes and patients without diabetes (HR 1.09; 95% CI 0.49–2.45). Regarding the selection of arterial conduits, grafting via the bilateral internal mammary artery (BIMA) decreased the risk of overall death (HR 0.67, 95% CI 0.52–0.85) and cardiovascular death (HR 0.55, 95% CI 0.35–0.87) without resulting in a significantly elevated rate of early death (RR 0.95, 95% CI 0.82–1.11). However, the evidence from PSM studies indicated no difference between the long-term mortality of the BIMA group and that of the single internal mammary arteries (SIMA) groups (HR 0.76, 95% CI 0.52–1.11), and the risk of SWI was significantly increased by BIMA in diabetes (RR 1.65, 95% CI 1.42–1.91). The ...

Review question / Objective: P: diabetic patients undergoing coronary artery bypass g r a f t s u r g e r y ; I : t o t a l a r t e r i a l revascularization; C: conventional surgery with saphenous veinsconventional surgery using veins; O: long-term all-cause death and cardiavascular death(≥1 year); early mortality (≤30 days); S: observational studies or randomized controlled trials.

Background and AimsThe clinical effects of multivessel interventions in patients with unstable angina/non‐ST‐segment elevation myocardial infarction (UA/NSTEMI), multivessel disease (MVD) and chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the safety and effectiveness of intervention in non‐culprit lession(s) among this cohort.MethodsWe consecutively included patients diagnosed with UA/NSTEMI, MVD and CKD between January 2008 and December 2018 at our centre. After successful percutaneous coronary intervention (PCI), we compared 48‐month overall mortality between those undergoing multivessel PCI (MV‐PCI) through a single‐procedure or staged‐procedure approach and culprit vessel‐only PCI (CV‐PCI) after 1:1 propensity score matching. We conducted stratified analyses and tests for interaction to investigate the modifying effects of critical covariates. Additionally, we recorded the incidence of contrast‐induced nephropathy (CIN) to assess the perioperative safety of the two treatment strategies.ResultsOf the 749 eligible patients, 271 pairs were successfully matched. Those undergoing MV‐PCI had reduced all‐cause mortality (hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.48–0.67). Subgroup analysis showed that those with advanced CKD (estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2) could not benefit from MV‐PCI (P = 0.250), and the survival advantage also tended to diminish in diabetes (P interaction < 0.01; HR = 0.95, 95% CI = 0.65–1.45). Although the staged‐procedure approach (N = 157) failed to bring additional survival benefits compared to single‐procedure MV‐PCI (N = 290) (P = 0.460), it showed a tendency to decrease the death risk. CIN risks in MV‐PCI and CV‐PCI groups were not significantly different (risk ratio = 1.60, 95% CI = 0.94–2.73).ConclusionAmong patients with UA/NSTEMI and non‐diabetic CKD and an eGFR > 30 mL/min/1.73 m2, MV‐PCI was associated with a reduced risk of long‐term death but did not increase the incidence of CIN during the management of MVD compared to CV‐PCI. And staged procedures might be a preferable option over single‐procedure MV‐PCI.