Abstract 16129: Optimal Treatment Strategies in Patients With Chronic Kidney Disease and Coronary Artery Disease: Insights From a Systemic Review and Meta-Analysis
Background: Chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD) and is associated with worse outcomes. However, only 10% to 40% of CAD patients with CKD undergo revascularization, due to fear of acute complications. However, data suggests that patients with CKD are more likely to die of cardiovascular causes than to reach end stage renal disease. The optimal treatment strategies is therefore unknown.
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 medical therapy (MT), percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) and followed for at least 1 month and reporting all-cause mortality. Analysis was performed to compare MT vs. any revascularization (PCI or CABG), MT vs. PCI alone, MT vs. CABG alone, and PCI vs. CABG strategy.
Results: 33 studies with 89,307 participants (73,379 revasc and 16,083 MT), fulfilled the criteria and were included in this analysis. Revascularization (PCI or CABG) was associated with reduced mortality over MT (OR 0.62; 95% CI 0.51-0.75). Similar lower mortality was found for PCI vs. MT (OR 0.63; 95% CI 0.51-0.79) and CABG vs. MT (OR 0.57; 95% CI 0.35-0.91). Similarly, CABG was associated with lower odds of death (OR 0.90; 95% CI 0.81-0.99) when compared to PCI (Figure).
Conclusions: In CAD patients with CKD, the current data from non-randomized studies indicate an association of lower mortality with revascularization, CABG or PCI when compared with MT. Furthermore, CABG was associated with lower mortality than PCI. These associations should be tested in future randomized trials.
- © 2013 by American Heart Association, Inc.