Abstract 16116: Drug Eluting vs. Bare Metal Stents in Patients With Chronic Kidney Disease and Coronary Artery Disease: Insight From a Systematic Review and Meta-Analysis of Trials
Background: Chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD) and is associated with an exponential increase in adverse outcomes. Most large clinical trials of drug eluting stents (DES) have excluded patients with impaired renal function. The efficacy of DES in patients with CKD is therefore not known.
Methods: MEDLINE, EMBASE and CENTRAL were searched for studies including at least 100 patients with CKD or with a creatinine clearance of ≤ 60 mL/min and CAD treated with DES or bare metal stents (BMS) and followed for at least 1 month and reporting outcomes of all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), target lesion and target vessel revascularizations.
Results: 27 studies with 83,332 participants (47,073 DES and 36,259 BMS) fulfilled the criteria and were included in the analysis. DES was associated with significant reduction in all-cause mortality (OR 0.70; 95% CI 0.61-0.80), CV mortality (OR 0.39; 95% CI 0.25-0.60), MI (OR 0.90; 95% CI 0.85-0.95), TLR (OR 0.61; 95% CI 0.48-0.77) and TVR (OR 0.49; 95% CI 0.35-0.69) when compared with BMS alone (Figure).
Conclusions: In CAD patients with CKD undergoing PCI, the current data from non-randomized studies indicate a significant benefit of DES when compared with BMS alone. These associations should be tested in future randomized controlled trials.
- © 2013 by American Heart Association, Inc.