Deo Salil V, Shah Ishan K, Dunlay Shannon M, Lim Ju Yong, Erwin Patricia J, Dillon John J, Park Soon J
Department of Cardiovascular Surgery, Adventist Wockhardt Heart Institute, Surat, Gujarat, India.
J Card Surg. 2014 Mar;29(2):163-9. doi: 10.1111/jocs.12296. Epub 2014 Jan 22.
The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved.
Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD.
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.
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%).
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.
终末期肾病（ESRD）患者多支冠状动脉疾病的最佳治疗方案尚未确定。
比较ESRD患者接受药物洗脱支架（DES）经皮介入治疗与冠状动脉旁路移植术（CABG）后的临床不良事件。
检索MEDLINE、科学网和Scopus数据库，查找2000年1月至2013年8月期间发表的英文相关研究。采用Peto法和随机效应模型估计合并比值比（OR）。数据以95%置信区间表示；p<0.05具有统计学意义。
纳入5项观察性研究（12035例DES患者；6317例CABG患者），随访期为27.4±6.3个月。DES组的早期死亡率（CABG组为8%，DES组为2.6%）较低（OR 0.29[0.14 - 0.59]；p = 0.0006；I² = 18%）。DES组再次干预的可能性更大（DES组为29%，CABG组为12%）（OR 3.72[2.24 - 6.18]：p<0.0001）。两组的晚期死亡率（27.4±7.3个月）相当（OR 0.72[0.40 - 1.29]；p = 0.27）。虽然DES组患者发生主要不良心脑血管事件（MACCE）的发生率（32%）略高于CABG组（25%），但差异无统计学意义（1.35[0.72 - 2.53]；p = 0.35；I² = 30%）。
关于该主题的数据仅限于小型回顾性研究。与冠状动脉旁路移植术相比，ESRD患者使用DES的早期死亡率较低。DES组再次干预率显著更高。在平均两年的汇总随访中，两组的死亡率和MACCE相当。
