Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients

Kumada, Yoshitaka; Ishii, Hideki; Aoyama, Toru; Kamoi, Daisuke; Kawamura, Y.; Sugihara, Takashi; Nogaki, H; Murohara, Toyoaki

doi:10.1253/circj.cj-13-1357

Cited by 39 publications

(28 citation statements)

References 29 publications

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“…Although some studies included single-vessel disease patients, the small number did not influence our analysis. Six studies included all types of dialysis patients [9, 18, 20-23], 10 studies included DES-only patients, and 1 study included bare-metal stent-only patients [8, 10, 11, 17, 19, 21-26]. Four studies included both DES and bare-metal stent patients [18, 20, 27, 28], and 2 studies did not report the type of stent used [9, 29].…”

Section: Resultsmentioning

confidence: 99%

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Luo

Fang

2019

Cardiorenal Med

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Background: Early revascularization can lead to better prognosis in multivessel coronary artery disease (CAD) patients with chronic kidney disease (CKD). However, whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is better remains unknown. Methods: We searched PubMed and the Cochrane Library database from inception until December 9, 2017, for articles that compare outcomes of CABG and PCI in multivessel CAD patients with CKD. We pooled the odds ratios with a fixed-effects model when I² < 50% or a random-effects model when I² > 75% and conducted heterogeneity and quality assessments as well as publication bias analyses. Results: A total of 17 studies with 62,343 patients were included. Compared with CABG, the pooled analysis showed that PCI had a lower risk of short-term all-cause death (OR, 0.56; 95% CI, 0.37–0.84) and cerebrovascular accidents (OR, 0.65; 95% CI, 0.53–0.79) but a higher risk of cardiac death (OR, 1.29; 95% CI, 1.21–1.37), myocardial infarction (MI) (OR, 1.73; 95% CI, 1.35–2.21), and repeat revascularization (RR) (OR, 3.9; 95% CI, 2.99–5.09). There was no significant difference in the risk of long-term all-cause death (OR, 1.08; 95% CI, 0.95–1.23) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99–2.52) between the PCI and CABG groups. A subgroup analysis restricted to patients treated with dialysis or with PCI-drug-eluting stent yielded similar results. Conclusions: PCI for patients with CKD and multivessel disease (multivessel CAD) had advantages over CABG with regard to short-term all-cause death and cerebrovascular accidents, but disadvantages regarding the risk of myocardial death, MI, and RR; there was no significant difference in the risk of long-term all-cause death and MACCE. Large randomized controlled trials are needed to confirm our findings.

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Section: Resultsmentioning

confidence: 99%

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Luo

Fang

2019

Cardiorenal Med

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“…[1][2][3][4][5][6][7][8][9][10][11] In addition, many patients develop major cardiac and cerebrovascular events or infections after discharge and the long-term results are not satisfactory. Yeo et al reported that the operative mortality of coronary artery bypass grafting (CABG) increased significantly with each stage of chronic kidney disease (CKD), and patients in stage 5 (estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m 2 or dialysis) had a far higher operative mortality than patients in stage 4 or lower.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

Sezai

Osaka

Yaoita

et al. 2016

ATCS

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Purpose: Recently, performance of cardiac surgery in hemodialysis patients has increased, but the mortality rate is high. Methods: We retrospectively examined the early and long-term outcomes in 128 dialysis patients who underwent cardiac surgery with or without carperitide infusion and were followed for 2 years. Sixty-three patients received carperitide infusion during surgery and 65 patients did not. Results: The hospital mortality rate was 1.6% in the carperitide group and 12.3% in the non-carperitide group, being significantly lower in the carperitide group. The 2-year actuarial survival rate was 90.5% ± 3.7% in the carperitide group, and 76.9% ± 5.2% in the non-carperitide group, while the major adverse cardiovascular and cerebrovascular events (MACCE)-free rate at 2 years postoperatively was 90.5% ± 3.7% in the carperitide group and 67.7% ± 5.8% in the non-carperitide group. Conclusions: These findings suggest that carperitide improves the early postoperative outcome in dialysis patients undergoing cardiac surgery, as has already been demonstrated in non-dialysis patients. An early postoperative cardioprotective effect of carperitide and improvement of renal function in oliguric patients might have contributed to this outcome. However, this was a retrospective study, so a prospective investigation is required to demonstrate the mechanisms involved. In addition, further evaluation of the long-term results would be desirable.

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“…Dialysis patients are more likely to have multivessel disease with complex, total occlusion, and multiple significant coronary lesions. 2 Furthermore, once patients on dialysis experience acute myocardial infarction (AMI), the risk of mortality increases by more than 50% at 1 year, and the long-term survival is poor, with a 5-year survival rate of only 10%. 3 …”

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confidence: 99%

Clinical Outcomes of Drug-Eluting Stents vs. Bare-Metal Stents in Acute Myocardial Infarction Patients Under Dialysis　– A Nationwide Cohort Study –

Chen

Mao

Tsai

et al. 2016

Circ J

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Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients

Cited by 39 publications

References 29 publications

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

Clinical Outcomes of Drug-Eluting Stents vs. Bare-Metal Stents in Acute Myocardial Infarction Patients Under Dialysis　– A Nationwide Cohort Study –

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Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients

Cited by 39 publications

References 29 publications

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Multivessel Coronary Revascularization Strategies in Patients with Chronic Kidney Disease: A Meta-Analysis

Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

Clinical Outcomes of Drug-Eluting Stents vs. Bare-Metal Stents in Acute Myocardial Infarction Patients Under Dialysis – A Nationwide Cohort Study –

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Clinical Outcomes of Drug-Eluting Stents vs. Bare-Metal Stents in Acute Myocardial Infarction Patients Under Dialysis　– A Nationwide Cohort Study –