title: Optimal method of coronary revascularization in patients receiving dialysis: systematic review.
abstract: OBJECTIVE
  Patients receiving dialysis have a high burden of cardiovascular disease. Some receive coronary artery revascularization but the optimal method is controversial.
  
  
  METHODS
  The authors reviewed any randomized controlled trial or cohort study of 10 or more patients receiving maintenance dialysis which compared coronary artery bypass graft (CABG) to percutaneous intervention (PCI) for revascularization of the coronary arteries. The primary outcomes were short-term (30 d or in-hospital) and long-term (at least 1 year) mortality.
  
  
  RESULTS
  Seventeen studies were found. There were no randomized trials: all were retrospective cohort studies from years 1977 to 2002. There were some baseline differences between the groups receiving CABG compared with those receiving PCI, and most studies did not consider results adjusted for such characteristics. Given the variability among studies and their methodological limitations, few definitive conclusions about the optimal method of revascularization could be drawn. In an exploratory meta-analysis, short-term mortality was higher after CABG compared to PCI. A substantial number of patients died over a subsequent 1 to 5 yr, with no difference in mortality after CABG compared to PCI.
  
  
  CONCLUSIONS
  Although decisions about the optimal method of coronary artery revascularization in dialysis patients are undertaken routinely, it was surprising to see how few data has been published in this regard. Additional research will help inform physician and patient decisions about coronary artery revascularization.
authors.affiliation: Division of Nephrology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Immaculate F
authors.initials: IF
authors.lastname: Nevis
authors.forename: Anna
authors.initials: A
authors.lastname: Mathew
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.forename: Arthur V
authors.initials: AV
authors.lastname: Iansavichus
authors.forename: Meaghan S
authors.initials: MS
authors.lastname: Cuerden
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D006435:Renal Dialysis; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome