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

Abstract

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.

Coronary revascularisation in patients with chronic kidney disease and end‐stage renal disease: A meta‐analysis

“…All included studies were considered of high quality because the NOS scores were not less than 7 for each study (Table 2 ). Table 3 summarising all other meta‐analysis papers 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 on this topic.…”

“…Table 3 summarising all other meta-analysis papers [42][43][44][45][46][47][48][49][50][51][52] on this topic.…”

Comparison of long-term cardiovascular and renal outcomes between percutaneous coronary intervention and coronary artery bypass grafting in multi-vessel disease with chronic kidney disease

“…While CABG was reported to be associated with a higher risk of short-term mortality and stroke, MI and repeat revascularization were less frequent than in those who had undergone PCI in the long-term follow-up ( 3 , 4 , 13 , 14 ). The majority of these studies designated MACCE as the primary outcome and concluded CABG is associated with fewer adverse events in patients with CKD than in PCI ( 14 , 15 ). However, some studies have published contrary findings ( 16 , 17 ), most likely due to differences in the stent type and definitions of the primary outcome.…”

Optimal treatment strategies for coronary artery disease in patients with advanced kidney disease: a meta-analysis

“…So this issue is very urgent and difficult. 43 Previous META analyses also studied similar content, but there were several limitations: [44][45][46] First, the targeted patient was patients with chronic kidney disease (eGFR < 60 ml/min/1.73 m 2 ), which included patients with mild to moderate renal failure. And the guidelines recommend mild to moderate renal failure patients with CAD undergo revascularization (PCI or CABG).…”