TY - JOUR
T1 - Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis A Systematic Review and Meta-Analysis
AU - Khera, Sahil
AU - Villablanca, Pedro A.
AU - Kolte, Dhaval
AU - Gupta, Tanush
AU - Khan, Mohammed Hasan
AU - Velagapudi, Poonam
AU - Kalra, Ankur
AU - Kleiman, Neal
AU - Aronow, Herbert D.
AU - Abbott, J. Dawn
AU - Rosenfield, Kenneth
AU - Drachman, Douglas E.
AU - Bangalore, Sripal
AU - Bhatt, Deepak L.
AU - Naidu, Srihari S.
N1 - Funding Information:
ISSN: 1061-5377/18/2606-0277 DOI: 10.1097/CRD.0000000000000192 Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Site Co-Investigator: Bio-tronik, Boston Scientific, St. Jude Medical; Unfunded Research: FlowCo, PLx Pharma, Takeda. Dr S.B. discloses the following relationships: Research grant from Abbott Vascular; Advisory board: Abbott Vascular; Research grant from NHLBI. Dr K.R. discloses the following relationships: Advisory Board: Abbott Vascular, Cardinal Health, Surmodics, Volcano-Philips, Cook, Amgen; Grant support/Research funding to institution: Angiodynamics, Atrium-Get-inge, Lutonix-BARD, National Institutes of Health, Inari Medical; Equity: PQ Bypass, Primacea, Vortex, MD Insider, Micell, Shockwave, Cruzar Systems, Endospan, Eximo, Valcare, Contego, Capture Vascular; Board of Directors: VIVA—501c3 corporation; President: Society for Cardiovascular Angiogra-phy and Interventions; President: National PERT Consortium - 501c3 corpora-tion. All other authors report no conflicts of interest.
Publisher Copyright:
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel–Haenszel method. Random-effects model was used for all analyses. A total of 17 nonrandomized studies (N = 63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis: median follow-up of 1 year (range: 9 months to 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95% CI 0.64–0.89, P < 0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95% CI 0.60–0.99, P = 0.047) and target lesion/vessel revascularization (OR 0.78, 95% CI 0.64–0.94, P = 0.01). However, there were no differences in noncardiovascular mortality, myocardial infarction, stent thrombosis, stroke, or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes after percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, target lesion/vessel revascularization, and cardiovascular death.
AB - There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel–Haenszel method. Random-effects model was used for all analyses. A total of 17 nonrandomized studies (N = 63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis: median follow-up of 1 year (range: 9 months to 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95% CI 0.64–0.89, P < 0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95% CI 0.60–0.99, P = 0.047) and target lesion/vessel revascularization (OR 0.78, 95% CI 0.64–0.94, P = 0.01). However, there were no differences in noncardiovascular mortality, myocardial infarction, stent thrombosis, stroke, or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes after percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, target lesion/vessel revascularization, and cardiovascular death.
KW - Dialysis
KW - Drug-eluting stents
KW - End-stage renal disease
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85054396485&partnerID=8YFLogxK
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U2 - 10.1097/CRD.0000000000000192
DO - 10.1097/CRD.0000000000000192
M3 - Review article
C2 - 30157064
AN - SCOPUS:85054396485
VL - 26
SP - 277
EP - 286
JO - Cardiology in review
JF - Cardiology in review
SN - 1061-5377
IS - 6
ER -