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Coronary artery bypass grafting versus percutaneous coronary intervention in end‐stage kidney disease: A systematic review and meta‐analysis of clinical studies
Author(s) -
Kanbay Mehmet,
Tapoi Laura,
Ureche Carina,
Bulbul Mustafa C.,
Kapucu Irem,
Afsar Baris,
Basile Carlo,
Covic Adrian
Publication year - 2021
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12946
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , myocardial infarction , coronary artery disease , relative risk , cardiology , dialysis , stroke (engine) , kidney disease , revascularization , hemodialysis , end stage renal disease , confidence interval , surgery , mechanical engineering , engineering
The most significant complication of end‐stage kidney disease (ESKD) is cardiovascular disease, mainly coronary artery disease (CAD). Although the effective treatment of CAD is an important prognostic factor, whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for treating CAD in this group of patients is still controversial. We searched Pubmed/Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials articles that compared the outcomes of CABG versus PCI in patients with ESKD requiring dialysis. A total of 10 observational studies with 39,666 patients were included. Our analysis showed that when compared to PCI, CABG had lower risk of need for repeat revascularization (relative risk [RR] = 2.25, 95% confidence interval [CI] 2.1–2.42, p < 0.00001) and cardiovascular death (RR = 1.19, 95% CI 1.14–1.23, p < 0.00001) and higher risk for short‐term mortality (RR = 0.43, 95% CI 0.38–0.48, p < 0.00001). There was no statistically significant difference between the PCI and CABG groups in the risk for late mortality (RR = 1.05, 95% CI 0.97–1.14, p = 0.25), myocardial infarction (RR = 1.05, 95% CI 0.46–2.36, p = 0.91) or stroke (RR = 1.02, 95% CI 0.64–1.61, p = 0.95). This meta‐analysis showed that in ESKD patients requiring dialysis, CABG was superior to PCI in regard to cardiovascular death and need for repeat revascularization and inferior to PCI in regard to short term mortality. However, this meta‐analysis has limitations and needs confirmation with large randomized controlled trials.