Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease

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• 作者：Ashok Krishnaswami ; MD ; MAS^a ; ^{ashok.krishnaswami@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Anne C.H. Goh ; MD^b ; Alan S. Go ; MD^c ; ^d ; ^e ; ^f ; Robert J. Lundstrom ; MD^b ; Jonathan Zaroff ; MD^b ; James J. Jang ; MD^a ; Elaine Allen ; PhD^d
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 May 2016
• 年：2016
• 卷：117
• 期：10
• 页码：1596-1603
• 全文大小：1204 K

文摘

The optimal coronary revascularization strategy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) in patients with end-stage renal disease (ESRD) remains uncertain. We performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD using a random-effects model for the primary outcome of long-term all-cause mortality. Our review registered through PROSPERO included observational studies published after 2011 to ensure overlap with previous studies and identified 7 new studies for a total of 23. We found that the median sample size in the selected studies was 125 patients (25 to 15,784) with a large variation in the covariate risk adjustment and only 3 studies reporting the indications for the revascularization strategy. CABG was associated with a small reduction in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant heterogeneity demonstrated (p = 0.005, I² = 48.6%). Subgroup analysis by categorized “year of study initiation” (<1990, 1991 to 2003, >2004) further confirmed the summary estimate trending toward survival benefit of CABG along with a substantial decrease in heterogeneity after 2004 (p = 0.64, I² = 0%). In conclusion, our updated systematic review and meta-analysis demonstrated that in patients with ESRD referred for coronary revascularization, CABG was associated with a small decrease in the relative risk of long-term mortality compared with PCI. The generalizability of the finding to all patients with ESRD referred for coronary revascularization is limited because of a lack of known indications for coronary revascularization, substantial variation in covariate risk adjustment, and lack of randomized clinical trial data.