Faculty of Medicine, Minia University, Minia, Egypt.
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Int Urol Nephrol. 2023 Oct;55(10):2493-2499. doi: 10.1007/s11255-023-03546-9. Epub 2023 Mar 12.
To study the most beneficial coronary revascularization strategy in kidney transplant recipients (KTR).
In 16th June 2022 and updated on 26th February 2023, we searched in five databases including PubMed for relevant articles. The odds ratio (OR) together with the 95% confidence interval (95%CI) were used to report the results.
Percutaneous coronary intervention (PCI) was significantly associated with significant lower in-hospital mortality (OR 0.62; 95%CI 0.51-0.75) and 1-year mortality (OR 0.81; 95%CI 0.68-0.97), but not overall mortality (mortality at the last follow-up point) (OR 1.05; 95%CI 0.93-1.18) rather than coronary artery bypass graft (CABG). Moreover, PCI was significantly associated with lower acute kidney injury prevalence (OR 0.33; 95%CI 0.13-0.84) compared to CABG. One study indicated that non-fatal graft failure prevalence did not differ between the PCI and the CABG group until 3 years of follow up. Moreover, one study demonstrated a short hospital length of stay in the PCI group rather than the CABG group.
Current evidence indicated the superiority of PCI than CABG as a coronary revascularization procedure in short- but not long-term outcomes in KTR. We recommend further randomized clinical trials for demonstrating the best therapeutic modality for coronary revascularization in KTR.
研究肾移植受者（KTR）最有益的冠状动脉血运重建策略。
在 2022 年 6 月 16 日和 2023 年 2 月 26 日更新时，我们在五个数据库中（包括 PubMed）搜索了相关文章。使用比值比（OR）及其 95%置信区间（95%CI）报告结果。
经皮冠状动脉介入治疗（PCI）与住院期间死亡率显著降低（OR 0.62；95%CI 0.51-0.75）和 1 年死亡率（OR 0.81；95%CI 0.68-0.97）显著相关，但与全因死亡率（最后随访点的死亡率）（OR 1.05；95%CI 0.93-1.18）无关，而非冠状动脉旁路移植术（CABG）。此外，与 CABG 相比，PCI 与较低的急性肾损伤发生率（OR 0.33；95%CI 0.13-0.84）显著相关。一项研究表明，在 3 年随访期间，PCI 组和 CABG 组之间非致命移植物失功发生率没有差异。此外，一项研究表明，PCI 组的住院时间短于 CABG 组。
目前的证据表明，在 KTR 中，PCI 作为一种冠状动脉血运重建术，在短期而不是长期结果中优于 CABG。我们建议进一步进行随机临床试验，以证明 KTR 冠状动脉血运重建的最佳治疗方式。
