Coronary artery bypass grafting versus drug-eluting stents in patients with end-stage renal disease

Salil V. Deo, Ishan K. Shah, Shannon M Dunlay, Ju Yong Lim, Patricia J. Erwin, John J. Dillon, Soon J. Park

Research output: Contribution to journalArticle

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Abstract

Background The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved. Aim of Study Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. Methods 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. Results 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; I2 = 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; I2 = 30%). Conclusion 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. doi: 10.1111/jocs.12296 (J Card Surg 2014;29:163-169)

Original languageEnglish (US)
Pages (from-to)163-169
Number of pages7
JournalJournal of Cardiac Surgery
Volume29
Issue number2
DOIs
StatePublished - 2014

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Drug-Eluting Stents
Coronary Artery Bypass
Chronic Kidney Failure
Odds Ratio
Mortality
MEDLINE
Observational Studies
Coronary Artery Disease
Language
Retrospective Studies
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Coronary artery bypass grafting versus drug-eluting stents in patients with end-stage renal disease. / Deo, Salil V.; Shah, Ishan K.; Dunlay, Shannon M; Lim, Ju Yong; Erwin, Patricia J.; Dillon, John J.; Park, Soon J.

In: Journal of Cardiac Surgery, Vol. 29, No. 2, 2014, p. 163-169.

Research output: Contribution to journalArticle

Deo, Salil V. ; Shah, Ishan K. ; Dunlay, Shannon M ; Lim, Ju Yong ; Erwin, Patricia J. ; Dillon, John J. ; Park, Soon J. / Coronary artery bypass grafting versus drug-eluting stents in patients with end-stage renal disease. In: Journal of Cardiac Surgery. 2014 ; Vol. 29, No. 2. pp. 163-169.
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abstract = "Background The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved. Aim of Study Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. Methods 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. Results 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; I2 = 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; I2 = 30{\%}). Conclusion 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. doi: 10.1111/jocs.12296 (J Card Surg 2014;29:163-169)",
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AU - Dillon, John J.

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N2 - Background The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved. Aim of Study Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. Methods 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. Results 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; I2 = 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; I2 = 30%). Conclusion 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. doi: 10.1111/jocs.12296 (J Card Surg 2014;29:163-169)

AB - Background The optimal treatment for multivessel coronary artery disease in patients with end-stage renal disease (ESRD) is unresolved. Aim of Study Compare clinical adverse events after percutaneous intervention with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. Methods 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. Results 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; I2 = 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; I2 = 30%). Conclusion 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. doi: 10.1111/jocs.12296 (J Card Surg 2014;29:163-169)

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