Coronary artery bypass grafting versus drug-eluting stents in patients with end-stage renal disease

Abstract

Background: The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved.

Aim of study: Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD.

Methods: MEDLINE, Web of Science, and Scopus were searched for appropriate studies published in the English language (between January 2000 and August 2013). The pooled odds ratio (OR) was estimated by the Peto method with a random effect model. Data are presented with 95% confidence interval; p<0.05 is significant.

Results: Five observational studies (12,035 DES patients; 6317 CABG) with a follow-up period of 27.4 ± 6.3 months were included. Early mortality (CABG 8% and DES 2.6%) was less in the DES cohort (OR 0.29 [0.14-0.59]; p=0.0006; I(2)=18%). Repeat intervention (DES 29% and CABG 12%) was more likely in the DES cohort (OR 3.72 [2.24-6.18]: p<0.0001). Late mortality (27.4 ± 7.3 months) was comparable in both cohorts (OR 0.72 [0.40-1.29]; p=0.27). While DES cohort (32%) patients suffered a slightly higher incidence of major adverse cardiac and cerebrovascular events (MACCE) as compared to CABG (25%), this was not significant (1.35 [0.72-2.53]; p=0.35; I(2)=30%).

Conclusion: Data regarding this topic are limited to small retrospective studies. Early mortality is lower with DESs compared with coronary artery bypass in patients with ESRD. Rate of reintervention is significantly higher in the DES cohort. At a mean pooled follow-up of two years, both mortality and MACCE are comparable in both cohorts.