title: Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) have high risks of coronary artery disease (CAD). Coronary revascularization is beneficial for long-term survival, but the optimal strategy remains still controversial.
  
  
  METHODS
  We searched studies that have compared percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for revascularization of the coronary arteries in CKD patients. Short-term (30 days or in-hospital) mortality, long-term (at least 12 months) all-cause mortality, cardiac mortality and the incidence of late myocardial infarction and recurrence of revascularization were estimated.
  
  
  RESULTS
  28 studies with 38,740 patients were included. All were retrospective studies from 1977 to 2012. Meta-analysis showed that PCI group had lower short-term mortality (OR 0.55, 95% CI 0.41 to 0.73, P<0.01), but had higher long-term all-cause mortality (OR 1.29, 95% CI 1.23 to 1.35, P<0.01). Higher cardiac mortality (OR 1.08, 95% CI 1.01 to 1.15, P<0.05), higher incidence of late myocardial infarction (OR 1.78, 95% CI 1.65 to 1.91, P<0.01) and recurring revascularization rate (OR 2.94, 95%CI 2.15 to 4.01, P<0.01) is found amongst PCI treated patients compared to CABG group.
  
  
  CONCLUSIONS
  CKD patients with CAD received CABG had higher risk of short-term mortality but lower risks of long-term all-cause mortality, cardiac mortality and late myocardial infarction compared to PCI. This could be due to less probable repeated revascularization.
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Sun Yat-sen University, West Yanjiang Road 107, Guangzhou, Guangdong, 510120, China.
authors.forename: Yu-Yang
authors.initials: YY
authors.lastname: Chen
authors.forename: Jing-Feng
authors.initials: JF
authors.lastname: Wang
authors.forename: Ying-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Shuang-Lun
authors.initials: SL
authors.lastname: Xie
authors.forename: Ru-Qiong
authors.initials: RQ
authors.lastname: Nie
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome