Review articleOptimal strategy of coronary revascularization in chronic kidney disease patients: A meta-analysis
Introduction
The prevalence of chronic kidney disease (CKD) has accounted for nearly 10% of the global population [1], [2]. CKD is ascribed to be an independent risk factor for coronary artery disease (CAD) [3], [4], [5], [6]. Furthermore, several cross-sectional studies have found a higher prevalence of various CAD risk factors among CKD patients, as opposed to people with normal kidney function [7], [8]. CKD patients with CAD often have multivessel coronary disease and elevated mortality than those with normal renal function [9], [10]. There are growing evidences that coronary revascularization is an effective strategy to reduce the cardiac mortality and improves prognosis compared to medical treatment for CKD patients with CAD [11], [12], [13], [14]. Therefore, an optimal strategy of coronary revascularization is highly desirable.
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is the optimal strategy for CKD patients. Two large-size sample studies from Herzog revealed that CABG had better long-term survival rate, but higher short-term mortality compared to PCI in dialysis patients [15], [16]. Whilst Fujimoto's study suggested that PCI had superiority in both short-term survival rate and long-term outcomes for end-stage renal disease (ESRD) patients [17]. A prior meta-analysis published by Nevis in 2009 showed that PCI had lower short-term mortality and higher long-term mortality for dialysis patients with CAD [18]. Recently, new innovations of each coronary revascularization step were introduced to CKD patients. Therefore, it is necessary to make an in-depth evaluation between the two strategies mentioned above. Herein, we performed a meta-analysis including all existing studies to compare the short-and long-term outcomes for the CKD patients with CAD who underwent either PCI or CABG.
Section snippets
Search Strategy and Selection Criteria
We performed the search on Medline, EMBASE, Ovid, Clinical Evidence Online, the ISI Science Citation Index, BIOSIS previews, Cochrane databases and CNKI. The follwing key words was used: “chronic kidney disease”, “chronic renal insufficiency”, “chronic renal failure”, “percutaneous transluminal coronary angioplasty”, “percutaneous coronary intervention”, “bare metal stent(BMS) ”, “drug-eluting stent(DES)”, “coronary artery bypassgraft surgery”. Cross-reference searches were completed via
Description of Screening Flow and Baseline Characteristics
We preliminarily screened 2341 citations and excluded 2313 articles, resulting in 28 retrospective studies for analysis from 8 different countries (Fig. 1). A total of 38,740 patients were included in the analysis (21,037 who underwent PCI and 17,703 who underwent CABG). Only four studies were referred to the inclusion criteria of PCI and CABG.
The baseline characteristics of all patients were shown in Table S1. The average age of PCI and CABG groups was approximately 62 and 61 respectively. The
Discussion
It is well known that CKD patients with CAD who received coronary revascularization had poorer outcomes than general population with normal kidney function [21], [22], [23], [24]. However, multiple studies suggested that CKD patients with CAD who received early coronary revascularization had superior outcomes and lower mortality compared with medical treatment [12], [25], [26], [27]. Despite that most of patients with renal dysfunction have been excluded from randomized acute coronary syndrome
Learning Points
We believe the paper could be of particular interest to the readers of your journal as we as we have shown the following information in the paper.
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Comprehensive searches for eligible studies;
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Studies have reported conflicting outcomes on the optimal strategy of coronary revascularization for CKD patients with CAD. Dr. Nevis and his colleagues performed a meta-analysis concerning this issue and reported that PCI had a lower short-term but higher long-term mortality for dialysis patients with CAD
Conflict of Interests
We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript.
Disclosure Statement
There is no conflict of interest in this manuscript.
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