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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Left Main Revascularization in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Ioannis Gialamas1, Konstantinos Kalogeras1, Panteleimon Pantelidis1
13rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Coronary artery bypass grafting (CABG) shows better long-term outcomes than percutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) patients with chronic kidney disease (CKD). This meta-analysis highlights CKD as a critical factor in revascularization decisions.
Area of Science:
- Cardiovascular Medicine
- Nephrology
Background:
- Left main coronary artery disease (LMCAD) poses significant risks, especially when co-occurring with chronic kidney disease (CKD).
- Revascularization strategies, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), are crucial for managing LMCAD.
- The impact of CKD on the comparative effectiveness of PCI versus CABG in LMCAD patients remains an area of active investigation.
Purpose of the Study:
- To systematically review and meta-analyze existing evidence comparing PCI and CABG in patients with LMCAD and CKD.
- To evaluate the impact of CKD on major adverse cardiac and cerebrovascular events (MACCE) following revascularization for LMCAD.
Main Methods:
- A comprehensive literature search was performed across PubMed, Embase, and CENTRAL.
- A pre-registered study protocol (PROSPERO ID: CRD42024496529) guided the systematic review and meta-analysis.
- The primary endpoint was MACCE, a composite of all-cause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization.
Main Results:
- Seven studies involving 3,475 patients were analyzed.
- PCI was associated with a significantly higher incidence of MACCE (HR: 1.50; 95% CI 1.26-1.79), driven by increased all-cause mortality, MI, and ischemia-driven revascularization.
- No significant differences were observed in stroke rates or 30-day all-cause mortality between PCI and CABG.
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates superior long-term outcomes compared to percutaneous coronary intervention (PCI) for patients with LMCAD and CKD.
- Chronic kidney disease (CKD) may significantly influence clinical outcomes in LMCAD patients, warranting consideration in treatment decisions.
- Further randomized controlled trials stratified by CKD stage are necessary to optimize revascularization strategies in this high-risk population.
Introduction/Objective:
This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).
Methods:
A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.
Results:
Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,376 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.78), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.79), MI (HR: 1.76; 95% CI 1.15-2.71), and ischemiadriven revascularization (HR: 3.66; 95% CI 1.84-7.30). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 1.28; 95% CI 0.85- 1.94).
Discussion:
While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, MI, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.
Conclusion:
CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.
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