Myocardial revascularisation in renal dysfunction: a systematic review and meta-analysis

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is common in end-stage renal disease (ESRD) patients.
• Limited randomized controlled trials (RCTs) exist, with conflicting data from retrospective studies.
• This study systematically reviews outcomes of PCI vs. CABG in ESRD patients, focusing on contemporary drug-eluting stent (DES) data.

Purpose of the Study:

• To compare clinical outcomes of PCI and CABG in patients with ESRD and renal dysfunction.
• To evaluate the impact of contemporary drug-eluting stents on these outcomes.
• To provide evidence-based guidance for revascularization strategies in this high-risk population.

Main Methods:

• Systematic review and meta-analysis of RCTs and observational studies.
• Searched MEDLINE, EMBASE, World of Science, and Cochrane Library.
• Analyzed outcomes including early mortality, myocardial infarction, repeat revascularization, and angina using random effect models.

Main Results:

• Included 1 RCT and 15 observational studies (7588 PCI, 9206 CABG patients).
• PCI showed lower early mortality (4.2% vs. 8.5%; RR=0.51).
• CABG had significantly lower repeat revascularization rates (7.3% vs. 17.8%).
• Even with DES, CABG favored lower repeat revascularization (5% vs. 14%) and MACE (15% vs. 27%), while DES-PCI had less early mortality (2.4% vs. 5.1%).

Conclusions:

• CABG is associated with higher early mortality compared to PCI in ESRD patients.
• Percutaneous intervention, even with drug-eluting stents, leads to a significantly higher need for repeat revascularization.
• Treatment decisions require careful consideration of trade-offs between early mortality and long-term revascularization needs.