Revascularization vs. Conservative Medical Treatment in Patients With Chronic Kidney Disease and Coronary Artery Disease: A Meta-Analysis

Liao, Guang‐zhi; Li, Yiming; Bai, Lin; Ye, Yu‐yang; Peng, Yong

doi:10.3389/fcvm.2021.818958

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…In addition, maintenance dialysis patients regularly display an “oligo-symptomatic” presentation of CAD ( 9 ), and the coronary artery has severe stenosis and calcification when symptoms appear, which increases the challenges and risks of surgery, especially PCI. Therefore, these high-risk patients in our clinical practice are undertreated with revascularization therapy due to perioperative complications and bleeding events ( 10 ). Moreover, there are no unified guidelines to standardize the management and treatment of such special groups.…”

Section: Introductionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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BackgroundThe primary cause of death among maintenance dialysis patients is coronary artery disease (CAD). However, the best treatment plan has not yet been identified.MethodsThe relevant articles were retrieved from various online databases and references from their inception to October 12, 2022. The studies that compared revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] with medical treatment (MT) among maintenance dialysis patients with CAD were selected. The outcomes evaluated were long-term (with a follow-up of at least 1 year) all-cause mortality, long-term cardiac mortality, and the incidence rate of bleeding events. Bleeding events are defined according to TIMI hemorrhage criteria: (1) major hemorrhage, intracranial hemorrhage or clinically visible hemorrhage (including imaging diagnosis) with decrease of hemoglobin concentration ≥5 g/dl; (2) minor hemorrhage, clinically visible bleeding (including imaging diagnosis) with a drop in hemoglobin of 3–5 g/dl; (3) minimal hemorrhage, clinically visible bleeding with hemoglobin drop <3 g/dl. In addition, revascularization strategy, CAD type, and the number of diseased vessels were considered in subgroup analyses.ResultsA total of eight studies with 1,685 patients were selected for this meta-analysis. The current findings suggested that revascularization was associated with low long-term all-cause mortality and long-term cardiac mortality but a similar incidence rate of bleeding events compared to MT. However, subgroup analyses indicated that PCI is linked to decreased long-term all-cause mortality compared to MT but CABG did not significantly differ from MT in terms of long-term all-cause mortality. Revascularization also showed lower long-term all-cause mortality compared to MT among patients with stable CAD, single-vessel disease, and multivessel disease but did not reduce long-term all-cause mortality among patients with ACS.ConclusionLong-term all-cause mortality and long-term cardiac mortality were reduced by revascularization in comparison to MT alone in patients undergoing dialysis. Larger randomized studies are needed to confirm the conclusion of this meta-analysis.

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Section: Introductionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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“…Previous studies showed that patients undergoing PCI who have CKD have a higher mortality rate. 1 This may be associated with their increased bleeding complications, peri-procedural myocardial infarction and in-stent thrombosis after PCI. 2 This also demonstrates that CKD is associated with a worsening prognosis in patients with coronary artery disease (CAD).…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of dynamic evolution in renal function among patients undergoing elective percutaneous coronary intervention

Xiang

Lin

Cai

et al. 2023

Preprint

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Background: Previous studies have shown that chronic kidney disease(CKD) affected the long-term prognosis of patients underwent the elective percutaneous coronary intervention(EPCI). However, the prognostic impact in patients with the development of the contrast-associated acute kidney injury(CA-AKI) and recovery or progression of CA-AKI were controversial. For the moment, little attention has been paid to the relationship between the dynamic evolution of renal function and its prognosis. Methods: We used three stages to characterize the dynamic evolution of renal function, namely the occurrence of CKD at baseline, the occurrence of CA-AKI in the postoperative period and the occurrence of post kindey injury(PKI) at 3 - 6 months postoperatively. Cardiac death and all-cause mortality were used as the endpoint of the study. PKI(+) was defined as CA-AKI not recovered or an increase in absolute serum creatinine (SCr) {greater than or equal to}0.3 mg/dl or a SCr relative increase in creatinine {greater than or equal to} 50% after 3 - 6 months. PKI(-) was defined as CA-AKI recovered or SCr elevation not meeting the PKI(+) requirement. Results: We prospectively enrolled 2951 patients who underwent EPCI from 2012 to 2018. They were divided into three groups according to baseline CKD and CA-AKI: STAGE I[Unimpaired renal function group, CKD(-)/CA-AKI(-) (n=1247)], STAGE II[Partially impaired renal function group, IIa: CKD(-)/CA-AKI(+) (n=91) and IIb: CKD(+)/CA-AKI(-) (n=1472)] and STAGE III[severely impaired renal function group, CKD(+)/CA-AKI(+) (n=141)]. Subsequently, based on the occurrence of PKI, they were divided into six groups: STAGE I/PKI(-) (n=1212), STAGE I/PKI(+) (n=35), STAGE II/PKI(-) (n=1508), STAGE II/PKI(+) (n=55), STAGE III/PKI(-) (n=108), STAGE III/PKI(+) (n=33). In a mean follow-up period of 3.33{plus minus} 1.39 years, we found that from STAGE I, STAGE II to STAGE III at baseline groups, the incidence of the primary outcome significantly increased. Meanwhile, from the baseline groups to the follow-up groups, the dynamic changes in renal function were observed. At the follow-uo groups, the occurrence of PKI did not affect the prognosis of patients in the STAGE I group(hazard ratio [HR] = 0.94, 95%CI: 0.15-8.11, p = 0.949) and the STAGE III group(hazard ratio [HR] = 1.19, 95%CI: 0.50-2.83 p = 0.689). However, for the STAGE II group (hazard ratio [HR] = 2.65, 95%CI: 1.42-4.94, p = 0.002), the development of PKI would lead to a poor prognosis for patients. Conclusion: In patients undergoing EPCI, the occurrence of CKD and CA-AKI affected the long-term prognosis of patients. The prognostic impact of the occurrence of PKI depended on the renal function of patients. In patients with unimpaired renal function or severely impaired renal function, the prognostic impact of PKI was negligible. However, in patients with partially impaired renal function, avoidance of PKI could beneficial for their long-term prognosis.

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“…Patients with renal impairment have a higher incidence of coronary artery disease (CAD) and face greater mortality risks. However, there is a lack of clear guidance on the optimal treatment approach for CAD in this patient population, primarily due to their exclusion from major clinical trials and studies (1)(2)(3)(4)(5)(6). Furthermore, there is limited research investigating the outcomes of complete coronary revascularization in patients with impaired renal function, despite suggestions that it may yield better results compared to incomplete revascularization.…”

Section: Introductionmentioning

confidence: 99%

Complete Surgical Myocardial Revascularization in Patients with Declined Renal Functions: 12-month Outcomes

KAYA

Bulut

Lopes³

et al. 2023

Preprint

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Introduction: This retrospective comparative study aimed to evaluate the feasibility and effectiveness of complete revascularization coronary artery bypass grafting (CABG) in patients with multi-vessel disease (MVD)-CAD and declined renal functions, addressing the knowledge gap regarding optimal treatment strategies and outcomes in this specific patient population. Methods: Between 2020 and 2022, a total of 58 patients underwent on-pump coronary artery bypass grafting surgery for complete myocardial revascularization in this study. To assess overall survival, Kaplan-Meier with the log-rank test was conducted for statistical analysis Results: The mean age of cohort was 60.7. The findings showed a high prevalence of medical conditions such as hypertension (50.0%), diabetes (50.0%), and anaemia (41.4%) among the participants. Intraoperatively, low cardiac output syndrome was reported in 5.2% of cases, while perioperative outcomes indicated a need for transfusions in 53.5% of cases and an in-hospital mortality rate of 3.4%. At the 12-month follow-up, no redo revascularization or renal replacement therapy was required, but cardiac mortality was 5.2% and all-cause mortality was 6.9%. Conclusions: The study concluded that complete revascularization is safe for these patients and highlights the potential benefits, emphasizing the need for further research in optimizing revascularization techniques for this population.

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Revascularization vs. Conservative Medical Treatment in Patients With Chronic Kidney Disease and Coronary Artery Disease: A Meta-Analysis

Cited by 11 publications

References 36 publications

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Prognostic impact of dynamic evolution in renal function among patients undergoing elective percutaneous coronary intervention

Complete Surgical Myocardial Revascularization in Patients with Declined Renal Functions: 12-month Outcomes

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