Drug-eluting stents in patients with end-stage renal disease: meta-analysis and systematic review of the literature.
OBJECTIVE
The study sought to examine the total weight of evidence regarding the use of drug eluting (DES) and bare metal stents (BMS) in patients with end stage renal disease (ESRD).


BACKGROUND
The potential superiority of DES over BMS in reducing target lesion or vessel revascularization (TLR or TVR) in patients with ESRD on dialysis has not been established. Small studies comparing DES to BMS in this population have yielded inconclusive results mainly due to the small sample size.


METHODS
We searched MEDLINE, EMBASE, Science Citation Index, CINAHL, and the Cochrane CENTRAL database of controlled clinical trials (December 2009) for controlled trials comparing DES to BMS in ESRD patients. We conducted a fixed-effects meta-analysis across seven eligible studies (n = 869 patients).


RESULTS
Compared with BMS-treated patients, DES-treated patients had significantly lower TLR/TVR (OR 0.55 CI: 0.39-0.79) and major adverse cardiac events (MACE) (OR 0.54; CI: 0.40-0.73). The absolute risk reduction (ARR) with DES in TLR/TVR was -0.09 (CI: -0.14 to -0.04; NNT 11) and in MACE was -0.13 (CI: -0.19 to -0.07; NNT 8). A trend towards lower incidence of all cause mortality was also noted with DES (OR 0.68; CI: 0.45-1.01). No significant differences were noted between both groups in the relative or absolute risk of myocardial infarction.


CONCLUSIONS
The use of DES in patients with ESRD is safe and yields significant reduction in the risk of TLR/TVR and MACE. Larger randomized studies are needed to confirm the results of this meta-analysis and establish the appropriate stent choice in this high risk population.
Abdel-Latif
Ahmed
A
Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky 40536-0200, USA.
Mukherjee
Debabrata
D
Mesgarzadeh
Paymon
P
Ziada
Khaled M
KM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D018579:Patient Selection; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D008670:Metals