Kannan Arun, Poongkunran Chithra, Medina Raul, Ramanujam Vendhan, Poongkunran Mugilan, Balamuthusamy Saravanan
1Department of Inpatient Medicine, University of Arizona, Tucson, AZ; and 2Angiocare, Tucson, AZ.
Am J Ther. 2016 Jan-Feb;23(1):e16-28. doi: 10.1097/MJT.0000000000000089.
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) on dialysis have an increased risk for cardiovascular mortality and morbidity secondary to occlusive coronary artery disease. Optimal revascularization strategy is unclear in this high-risk population. We have performed a meta-analysis to compare coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with ESRD and CKD. We searched PubMed, Ovid, MEDLINE, CINAHL, and EMBASE (1980-2013) and found 17 trials (N = 33,584) in the ESRD arm and 6 studies (n = 15,493) in the CKD arm. Two investigators independently collected the data. All the studies were retrospective trials. In the ESRD and CKD groups, we found significantly reduced early mortality with the PCI group with the odds ratio of 2.08 (1.90-2.26; P < 0.00001) and 2.55 (1.45-4.51; P = 0.001), respectively. Contrary to the early mortality results, we found decreased late mortality with the CABG group when compared with the PCI group [odds ratio: 0.86 (0.83-0.89; P < 0.000001) and 0.82 (0.76-0.88; P < 0.00001)] in the ESRD and CKD arm, respectively. When compared with PCI, there was decreased cardiovascular mortality with an odds ratio of 0.61 (0.40-0.92; P = 0.02) in patients who underwent CABG in ESRD population. Similar trends were observed in the incidence of myocardial infarction and repeat revascularization. There is a strong trend for decreased risk of stroke with PCI when compared with CABG in ESRD and CKD populations.
患有慢性肾脏病（CKD）以及接受透析治疗的终末期肾病（ESRD）患者，继发于闭塞性冠状动脉疾病的心血管疾病死亡率和发病率有所增加。在这一高危人群中，最佳的血运重建策略尚不清楚。我们进行了一项荟萃分析，比较ESRD和CKD患者接受冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）的效果。我们检索了PubMed、Ovid、MEDLINE、CINAHL和EMBASE（1980年至2013年），在ESRD组中找到17项试验（N = 33,584），在CKD组中找到6项研究（n = 15,493）。两名研究人员独立收集数据。所有研究均为回顾性试验。在ESRD组和CKD组中，我们发现PCI组的早期死亡率显著降低，比值比分别为2.08（1.90 - 2.26；P < 0.00001）和2.55（1.45 - 4.51；P = 0.001）。与早期死亡率结果相反，我们发现，在ESRD组和CKD组中，与PCI组相比，CABG组的晚期死亡率降低[比值比分别为：0.86（0.83 - 0.89；P < 0.000001）和0.82（0.76 - 0.88；P < 0.00001）]。在ESRD人群中，与PCI相比，接受CABG的患者心血管疾病死亡率降低，比值比为0.61（0.40 - 0.92；P = 0.02）。在心肌梗死发生率和再次血运重建方面也观察到类似趋势。在ESRD和CKD人群中，与CABG相比，PCI有使中风风险降低的强烈趋势。
