Optimal strategy of coronary revascularization in chronic kidney disease patients: A meta-analysis |
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| Authors: | Yu-Yang Chen Jing-Feng Wang Ying-Jun Zhang Shuang-Lun Xie Ru-Qiong Nie |
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| Affiliation: | 1. Department of Cardiology, The Second Affiliated Hospital of Sun Yat-sen University, West Yanjiang Road 107, Guangzhou, Guangdong, 510120, China;2. Department of Anesthesiology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, China;1. Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy;2. Dipartimento di Farmacia, Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy;3. Dipartimento di Area Critica Medico Chirurgica, Università degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy;1. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'' Andrea delle Fratte, 06156, Perugia, Italy;2. Stroke Unit and Division of Neurology, Ospedale “C. Poma”, Strada Lago Paiolo 10, 46100, Mantua, Italy;1. Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;2. Charité-Universitätsmedizin, Campus Virchow-Klinkum, Department of Internal Medicine–Cardiology, Berlin, Germany;3. Clinical Center Ni?, Department of Cardiology, Ni?, Serbia;4. Department of Internal Medicine–Cardilogy, University of Göttingen, Germany;5. Zvezdara University Medical Center, Department of cardiology, Belgrade, Serbia;6. Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;7. Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Germany;1. Pharmaceutical Department, Local Health Unit of Verona, Via Salvo D''Acquisto 7, 37122 Verona, Italy;2. Health Care Systems Department, CINECA — Consortium of Universities, Via Magnanelli 6/3, 40033 Casalecchio di Reno (BO), Italy;3. Department of Cardiac Thoracic and Vascular Sciences, University of Padova, School of Medicine, Via Giustiniani 2, 35128 Padova, Italy;1. Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China;2. Institute of Brain Science and State Key laboratory of Medical Neurobiology, Fudan University, 200032, Shanghai, China;1. Internal Medicine Department, Hospital Universitario Virgen del Rocío, Seville, Spain;2. Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain;3. Internal Medicine Department, Hospital General de Alicante, Spain;4. Internal Medicine Department, Chief of Medical Area, Hospital de Bormujos, Seville, Spain;5. Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain |
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| Abstract: | BackgroundPatients with chronic kidney disease (CKD) have high risks of coronary artery disease (CAD). Coronary revascularization is beneficial for long-term survival, but the optimal strategy remains still controversial.MethodsWe searched studies that have compared percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for revascularization of the coronary arteries in CKD patients. Short-term (30 days or in-hospital) mortality, long-term (at least 12 months) all-cause mortality, cardiac mortality and the incidence of late myocardial infarction and recurrence of revascularization were estimated.Results28 studies with 38,740 patients were included. All were retrospective studies from 1977 to 2012. Meta-analysis showed that PCI group had lower short-term mortality (OR 0.55, 95% CI 0.41 to 0.73, P < 0.01), but had higher long-term all-cause mortality (OR 1.29, 95% CI 1.23 to 1.35, P < 0.01). Higher cardiac mortality (OR 1.08, 95% CI 1.01 to 1.15, P < 0.05), higher incidence of late myocardial infarction (OR 1.78, 95% CI 1.65 to 1.91, P < 0.01) and recurring revascularization rate (OR 2.94, 95%CI 2.15 to 4.01, P < 0.01) is found amongst PCI treated patients compared to CABG group.ConclusionsCKD patients with CAD received CABG had higher risk of short-term mortality but lower risks of long-term all-cause mortality, cardiac mortality and late myocardial infarction compared to PCI. This could be due to less probable repeated revascularization. |
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