Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stents in Patients with Left Main Coronary Artery Disease and Chronic Kidney Disease: A Systematic Review and Meta-Analysis
| Autor: | Kewan Hamid, Saira Sundus, Ahmad Al-Abdouh, Mohammad Luay Alkotob, Laith Rashdan, Yazan Zayed, Ghassan Bachuwa, Babikir Kheiri, Owais Barbarawi, Mahmoud Barbarawi, Adam Chahine |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Clinical Decision-Making Coronary Artery Disease 030204 cardiovascular system & hematology Cochrane Library Lower risk Kidney Risk Assessment law.invention 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Percutaneous Coronary Intervention Randomized controlled trial law Risk Factors Internal medicine Medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Coronary Artery Bypass Renal Insufficiency Chronic Aged Aged 80 and over business.industry Patient Selection Percutaneous coronary intervention General Medicine Middle Aged medicine.disease Treatment Outcome Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | Cardiovascular revascularization medicine : including molecular interventions. 20(12) |
| ISSN: | 1878-0938 |
| Popis: | Background Treatment of left main coronary artery disease (LMCAD) in patients with chronic kidney disease (CKD) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. Therefore, we performed a meta-analysis to evaluate the optimal choice of therapy when treating LMCAD in patients with CKD. Method We performed an electronic database search of Pubmed, Embase , and Cochrane Library for all studies that compared PCI with CABG when treating LMCAD in the setting of CKD. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome. Secondary outcomes included myocardial infarction (MI), cerebrovascular events, all-cause mortality, and repeat revascularization . Results Our analysis included 5 studies (2 randomized controlled trial and 3 retrospective) representing a total of 1212 patients. Mean follow up was 3.4 ± 1.3 years. Our study demonstrated a significant reduction in MACCE for patients treated with CABG compared with PCI (odd ratio [OR] 0.72; 95% confidence interval [CI] 0.55–0.95, P = 0.02, I2 = 0%). We also found a significant reduction in both MI (OR 0.55; 95% CI 0.34–0.87; P = 0.01; I2 = 0%) and repeat revascularization (OR 0.22; 95% CI 0.10–0.51; P = 63%) in the CABG group. However, CABG was associated with increased risks of cerebrovascular disease events compared with PCI (OR 2.04; 95% CI 1.02–4.08; P = 0.04, I2 = 0%). Conclusion In patients with CKD requiring LMCAD intervention, CABG is associated with a lower risk of MACCE, MI, and repeat revascularization, however it was associated with an increased risk of cerebrovascular accidents when compared to patients who received PCI therapy. Further RCTs with sufficient power are required to confirm these findings. |
| Databáze: | OpenAIRE |
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