Does Chronic Kidney Disease Influence Revascularization Strategy After Acute Coronary Syndrome? A Systematic Review...

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Coronary artery bypass grafting (CABG) offers better long-term results than percutaneous coronary intervention (PCI) for complex multivessel coronary artery disease (CAD).
• Patients with chronic kidney disease (CKD) have a higher prevalence of multivessel CAD but face increased surgical risks.
• The study examines if CKD influences the choice between CABG and PCI in patients treated for acute coronary syndrome (ACS).

Purpose of the Study:

• To investigate the association between chronic kidney disease (CKD) and the utilization of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).
• To analyze real-world revascularization patterns in ACS patients with and without CKD.

Main Methods:

• A systematic literature search was conducted across Embase, MEDLINE, Scopus, and CENTRAL from 2012 to 2023.
• Included studies reported CABG rates in ACS patients with and without CKD (eGFR < 60 mL/min/1.73 m²).
• Random effects meta-analyses were performed to determine the odds of CABG in CKD patients, stratified by ACS type and dialysis status.

Main Results:

• Analysis of 13 observational studies (n=1,682,207) revealed that CKD patients were more likely to receive CABG than non-CKD patients (OR=1.50, 95% CI: 1.30-1.72).
• The association between CKD and CABG use was stronger in ST-elevation myocardial infarction (STEMI) (OR=1.54) compared to non-ST-elevation ACS (NSTE-ACS) (OR=1.16).
• After adjusting for lower coronary angiography use in CKD patients with NSTE-ACS, the association between CKD and CABG disappeared.

Conclusions:

• In high-income countries, ACS patients with CKD are more frequently treated with CABG compared to PCI.
• The observed higher CABG use in CKD patients with NSTE-ACS was attenuated when accounting for reduced invasive angiography rates.
• Increased access to invasive coronary angiography for NSTE-ACS patients with CKD could potentially improve revascularization rates and patient outcomes.