Comparison of Drug-Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta-Analysis.
Drug-eluting stents (DESs) and bare metal stents (BMSs) are both recommended to improve coronary revascularization and to treat coronary artery disease in patients with chronic kidney disease (CKD). However, the potential superiority of DESs over BMSs for reducing the incidence of long-term major adverse cardiovascular events and mortality in CKD patients has not been established, and the results remain controversial. We aimed to systematically assess and quantify the total weight of evidence regarding the use of DESs versus BMSs in CKD patients.



In this systematic review and conventional meta-analysis, electronic studies published in any language until May 20, 2016, were systematically searched through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials and observational studies comparing outcomes in CKD patients with DESs versus BMSs and extracted data in a standard form. Pooled odd ratios and 95% CIs were calculated using random- and fixed-effects models. Finally, 38 studies involving 123 396 patients were included. The use of DESs versus BMSs was associated with significant reductions in major adverse cardiovascular events (pooled odds ratio 0.75; 95% CI, 0.64-0.88; P<0.001), all-cause mortality (odds ratio 0.81; 95% CI, 0.73-0.90; P<0.001), myocardial infarction, target-lesion revascularization, and target-vessel revascularization. The superiority of DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials.



The use of DESs significantly improves the above outcomes in CKD patients. Nevertheless, large-sized randomized controlled trials are necessary to determine the real effect on CKD patients and whether efficacy differs by type of DES.
Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China.
Renjie
R
Lu
Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China.
Fenglei
F
Tang
Department of Internal Medicine, The Third People's Hospital of Changzhou, Jiangsu, China.
Yan
Y
Zhang
Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China.
Xishan
X
Zhu
Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China.
Shanmei
S
Zhu
Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China.
Ganlin
G
Wang
Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China.
Yinfeng
Y
Jiang
Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China yyyy20152015@126.com.
Zhengda
Z
Fan
D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D008670:Metals; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D015607:Stents; D016896:Treatment Outcome
D008670:Metals
bare metal stent; cardiac; cardiac biomarkers; chronic kidney disease; coronary disease; dialysis; drug‐eluting stent; outcomes