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Optimal method of coronary revascularization in patients receiving dialysis: systematic review

Immaculate F Nevis1, Anna Mathew, Richard J Novick

  • 1Division of Nephrology, University of Western Ontario, London, Ontario, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|February 17, 2009
PubMed

Insights

For patients on dialysis, coronary artery bypass grafting (CABG) showed higher short-term mortality than percutaneous intervention (PCI). Long-term mortality showed no significant difference between CABG and PCI for revascularization.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Interventional Cardiology

Background:

  • Patients undergoing dialysis face a high prevalence of cardiovascular disease.
  • Coronary artery revascularization is performed, but the optimal method remains debated.

Purpose of the Study:

  • To compare the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous intervention (PCI) for revascularization in dialysis patients.
  • To analyze short-term and long-term mortality outcomes.

Main Methods:

  • Systematic review and exploratory meta-analysis of randomized controlled trials and cohort studies.
  • Included studies involved 10 or more patients on maintenance dialysis comparing CABG to PCI.
  • Primary outcomes were 30-day/in-hospital and long-term (≥1 year) mortality.

Main Results:

  • Seventeen retrospective cohort studies (1977-2002) were identified; no randomized trials were found.
  • Baseline differences between CABG and PCI groups were noted, with limited adjustment in most studies.
  • Exploratory meta-analysis indicated higher short-term mortality with CABG compared to PCI. No significant difference in long-term mortality (1-5 years) was observed.

Conclusions:

  • Limited published data exists regarding optimal coronary revascularization methods in dialysis patients.
  • Methodological limitations of existing studies hinder definitive conclusions.
  • Further research is crucial to guide clinical decisions for this high-risk population.
Abstract

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