Percutaneous Coronary Intervention With Drug Eluting Stents Versus Coronary Artery Bypass Graft Surgery in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Doulamis, Ilias P.; Tzani, Aspasia; Tzoumas, Andreas; Iliopoulos, Dimitrios; Kampaktsis, Polydoros; Briasoulis, Αlexandros

doi:10.1053/j.semtcvs.2020.11.005

Cited by 11 publications

(11 citation statements)

References 32 publications

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“…Recent studies have suggested that the risk of stroke may decrease in the CABG group due to the increased use of off-pump surgery and the avoidance of aortic cross-clamping [ 16 ]. A meta-analysis pooling three cohort studies and three RCTs together reported that CABG was associated with a higher risk of stroke than PCI, in contrast to our findings [ 13 ]. Thus, further studies are required to confirm whether PCI and CABG are associated with a similar risk of stroke.…”

Section: Discussioncontrasting

confidence: 99%

“…Three RCTs on this topic have been published [ 4–6 ]. A meta-analysis including these three trials, which included a total of 1121 patients with CKD, reported that CABG was associated with a lower risk of mortality, MACCE, myocardial infarction, and repeat revascularization than PCI [ 13 ]. These results are consistent with the findings of the present meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, no meta-analysis has analyzed the results of propensity score-matching studies comparing prognosis between PCI and CABG in patients with CKD. Furthermore, previous meta-analyses have failed to conduct a subgroup analysis of long-term survival outcomes stratified by different estimated glomerular filtration rates (eGFRs) [ 12 , 13 ]. Therefore, we conducted an updated meta-analysis to obtain more persuasive results.…”

Section: Introductionmentioning

confidence: 99%

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Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention: a meta-analysis of propensity score-matching studies

Yang

Chen

2021

Renal Failure

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention: a meta-analysis of propensity score-matching studies

Yang

Chen

2021

Renal Failure

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Xiao

Zhang

2021

Int J Clin Pract

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Objectives To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for revascularising coronary arteries in patients with chronic kidney disease (CKD) and end‐stage renal disease (ESRD). CKD is described as a continuous decrease in the glomerular filtration rate or abnormalities in kidney structure or function. Methods PubMed, Cochrane Library and Embase databases were searched for studies on the revascularisation of coronary arteries in patients with CKD and ESRD. Results Since no randomised controlled trials (RCTs) have addressed this issue so far, 31 observational studies involving 74 805 patients were included in this meta‐analysis. Compared with PCI, patients undergoing CABG have significantly higher early mortality (CKD: RR = 1.62, 95% CI: 1.17‐2.25, pheterogeneity = 0.476, I2 = 0; ESRD: RR = 1.99, 95% CI: 1.46‐2.71, pheterogeneity = 0.001, I2 = 66.9%). Patients with ESRD undergoing CABG have significantly lower all‐cause mortality (RR = 0.95, 95% CI: 0.93‐0.96, pheterogeneity < 0.001, I2 = 82.9%) and cardiac mortality (RR = 0.73, 95% CI: 0.58‐0.92, pheterogeneity = 0.908, I2 = 0). The long‐term risk of repeat revascularisation (CKD: RR = 0.24, 95% CI: 0.19‐0.30, pheterogeneity = 0.489, I2 = 0; ESRD: RR = 0.23, 95% CI: 0.15‐0.34, pheterogeneity = 0.012, I2 = 54.4%) and myocardial infarction (CKD: RR = .57, 95% CI: 0.38‐0.85, pheterogeneity = 0.025, I2 = 49.9%; ESRD: RR = 0.42, 95% CI: 0.40‐0.44, pheterogeneity = 0.49, I2 = 0) remained significantly higher in the PCI group. Conclusions Patients with ESRD, but not CKD, who underwent CABG had significantly lower all‐cause mortality and cardiac mortality. However, CABG was associated with an increased risk of early mortality in patients with CKD or ESRD. Adequately powered, contemporary, prospective RCTs are needed to define the optimal revascularisation strategy for patients with CKD and ESRD.

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“…41 However, in a subgroup analysis including a total of 801 dialysis-dependent patients, PCI and CABG had similar outcomes in terms of all-cause mortality. 41 Further analysis of this subgroup was warranted due to the lack of data.…”

Section: Discussionmentioning

confidence: 95%

Percutaneous coronary intervention versus coronary artery bypass graft surgery in dialysis‐dependent patients: A pooled meta‐analysis of reconstructed time‐to‐event data

Tasoudis

Varvoglis

Tzoumas

et al. 2022

Journal of Cardiac Surgery

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Objective Το perform a systematic review with meta‐analysis of published data comparing outcomes between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in dialysis‐dependent patients. Methods We searched PubMed, Scopus, and Cochrane databases for studies including dialysis‐dependent patients who underwent either CABG or PCI. This meta‐analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. We conducted one‐stage and two‐stage meta‐analysis with Kaplan–Meier‐derived individual patient data for overall survival and meta‐analysis with the random‐effects model for the in‐hospital mortality and repeat revascularization. Results Twelve studies met our eligibility criteria, including 13,651 and 28,493 patients were identified in the CABG and PCI arms, respectively. Patients who underwent CABG had overall improved survival compared with those who underwent PCI at the one‐stage meta‐analysis (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.09–1.16, p < .0001) and the two‐stage meta‐analysis (HR: 1.15, 95% CI: 1.08–1.23, p < .001, I2 = 30.0%). Landmark analysis suggested that PCI offers better survival before the 8.5 months of follow‐up (HR: 0.96, 95% CI: 0.92–0.99, p = .043), while CABG offers an advantage after this timepoint (HR: 1.3, 95% CI: 1.22–1.32, p < .001). CABG was associated with increased odds for in‐hospital mortality (odds ratio [OR]: 1.70, 95% CI: 1.50–1.92, p < .001, I2 = 0.0%) and decreased odds for repeat revascularization (OR: 0.22, 95% CI: 0.14–0.34, p < .001, I2 = 58.08%). Conclusions In dialysis‐dependent patients, CABG was associated with long‐term survival but a higher risk for early mortality. The risk for repeat revascularization was higher with PCI.

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Percutaneous Coronary Intervention With Drug Eluting Stents Versus Coronary Artery Bypass Graft Surgery in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 32 publications

Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention: a meta-analysis of propensity score-matching studies

Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention: a meta-analysis of propensity score-matching studies

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

Percutaneous coronary intervention versus coronary artery bypass graft surgery in dialysis‐dependent patients: A pooled meta‐analysis of reconstructed time‐to‐event data

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