title: Drug-eluting stents versus bare-metal stents in patients with decreased GFR: a meta-analysis.
abstract: BACKGROUND
  Decreased estimated glomerular filtration rate (eGFR) is a strong predictor of both mortality and subsequent cardiac events after percutaneous coronary intervention. The safety and efficacy of drug-eluting (DESs) versus bare-metal stents (BMSs) in this population have not been evaluated adequately.
  
  
  METHODS
  A systematic review and meta-analysis.
  
  
  METHODS
  Studies involving the comparison of clinical outcomes between DESs and BMSs in patients with eGFR <60 mL/min/1.73 m(2). Studies exclusively involving patients with ST-segment elevation myocardial infarction were excluded.
  
  
  METHODS
  MEDLINE (on Ovid), EMBASE, and the Cochrane Library databases from 2002-2013 were searched for studies comparing DESs with BMSs in patients with eGFR <60 mL/min/1.73 m(2).
  
  
  METHODS
  DES versus BMS implantation.
  
  
  RESULTS
  Mortality, repeat revascularization, myocardial infarction, and stent thrombosis.
  
  
  RESULTS
  Data from 26 comparative studies with 66,840 patients were included. Compared with BMSs, DESs were associated with significant reductions in repeat revascularization (OR, 0.61; 95% CI, 0.50-0.74; P < 0.001) and myocardial infarction (OR, 0.85; 95% CI, 0.79-0.92; P < 0.001), with no detectable difference in stent thrombosis (OR, 0.72; 95% CI, 0.46-1.12; P = 0.1). The superiority of DESs over BMSs in decreasing mortality also was documented (OR, 0.77; 95% CI, 0.65-0.90; P = 0.01). This survival benefit of DESs over BMSs was attenuated in randomized controlled trials or adjusted observational studies versus unadjusted observational studies.
  
  
  CONCLUSIONS
  Most studies were observational studies. Meta-analysis was not performed on individual patient data.
  
  
  CONCLUSIONS
  DES use in patients with eGFR <60 mL/min/1.73 m(2) is associated with a reduced rate of repeat revascularization and myocardial infarction without increased risk of stent thrombosis. The true effect of DESs versus BMSs on mortality needs to be confirmed by randomized controlled trials.
authors.affiliation: Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhi Jian
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Kishore J
authors.initials: KJ
authors.lastname: Harjai
authors.forename: Chetan
authors.initials: C
authors.lastname: Shenoy
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.forename: Dong Mei
authors.initials: DM
authors.lastname: Shi
authors.forename: Yu Yang
authors.initials: YY
authors.lastname: Liu
authors.forename: Ying Xin
authors.initials: YX
authors.lastname: Zhao
authors.forename: Yu Jie
authors.initials: YJ
authors.lastname: Zhou
mesh_terms: D054855:Drug-Eluting Stents; D005919:Glomerular Filtration Rate; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology*; D011474:Prosthesis Design; D015607:Stents; D013927:Thrombosis / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: Kidney; coronary disease; meta-analysis; stents