Meta-analysis of clinical studies comparing coronary artery bypass grafting with percutaneous coronary intervention in patients with end-stage renal disease.
End-stage renal disease (ESRD) patients are at high risk for coronary artery disease (CAD). The optimal revascularization strategy remains unknown. We performed a meta-analysis of retrospective observational trials to compare coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for ESRD patients with CAD. A search of published reports was conducted to identify clinical studies comparing CABG with PCI in ESRD patients with CAD with a minimal follow-up of 12 months. Sixteen studies included 32 350 ESRD patients with revascularization. Compared with PCI, CABG was associated with a lower risk for late mortality [relative risk (RR) 0.90, 95% confidence interval (CI) 0.87-0.93], myocardial infarction event (RR 0.64, 95% CI: 0.61-0.68), repeat revascularization event (RR 0.22, 95% CI: 0.16-0.31) and cumulative events (RR 0.69, 95% CI: 0.65-0.73), despite having a higher risk for early mortality (RR 1.98, 95% CI: 1.51-2.60). In conclusion, the long-term results of PCI in ESRD patients are dismal, and CABG is significantly superior to PCI in this subset of patients.
Department of Cardiovascular Surgery,  Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,  China.
Hui
H
Zheng
Song
S
Xue
Feng
F
Lian
Ri-Tai
RT
Huang
Zhen-Lei
ZL
Hu
Yong-Yi
YY
Wang
D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome