Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China.
Am J Kidney Dis. 2013 Oct;62(4):711-21. doi: 10.1053/j.ajkd.2013.04.014. Epub 2013 Jun 14.
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.
A systematic review and meta-analysis.
SETTING & POPULATION: 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.
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).
DES versus BMS implantation.
Mortality, repeat revascularization, myocardial infarction, and stent thrombosis.
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.
Most studies were observational studies. Meta-analysis was not performed on individual patient data.
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.
估算肾小球滤过率（eGFR）降低是经皮冠状动脉介入治疗后死亡和随后发生心脏事件的强烈预测因素。在该人群中，药物洗脱支架（DESs）与裸金属支架（BMSs）的安全性和疗效尚未得到充分评估。
系统评价和荟萃分析。
研究涉及比较 eGFR <60 mL/min/1.73 m2的患者中 DESs 与 BMSs 的临床结局。排除了仅涉及 ST 段抬高型心肌梗死患者的研究。
2002 年至 2013 年期间，在 MEDLINE（Ovid）、EMBASE 和 Cochrane 图书馆数据库中搜索比较 eGFR <60 mL/min/1.73 m2的患者中 DESs 与 BMSs 的研究。
DES 与 BMS 植入。
死亡率、再次血运重建、心肌梗死和支架血栓形成。
纳入了 26 项比较研究，共 66840 例患者的数据。与 BMS 相比，DES 与再次血运重建（OR，0.61；95%CI，0.50-0.74；P < 0.001）和心肌梗死（OR，0.85；95%CI，0.79-0.92；P < 0.001）显著减少，支架血栓形成无差异（OR，0.72；95%CI，0.46-1.12；P = 0.1）。DESs 降低死亡率的优越性也得到了证明（OR，0.77；95%CI，0.65-0.90；P = 0.01）。DESs 相对于 BMSs 的生存获益在随机对照试验或调整后的观察性研究与未经调整的观察性研究相比有所减弱。
大多数研究为观察性研究。未对个体患者数据进行荟萃分析。
在 eGFR <60 mL/min/1.73 m2的患者中使用 DES 可降低再次血运重建和心肌梗死的发生率，而支架血栓形成的风险无增加。DESs 与 BMSs 对死亡率的实际影响需要通过随机对照试验来证实。
