Abstract
BackgroundAs a strong risk factor for coronary artery disease (CAD), chronic kidney disease (CKD) indicates higher mortality in patients with CAD. However, the optimal treatment for the patients with two coexisting diseases is still not well defined.MethodsTo conduct a meta-analysis, PubMed, Embase, and the Cochrane database were searched for studies comparing medical treatment (MT) and revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] in adults with CAD and CKD. Long-term all-cause mortality was evaluated, and subgroup analyses were performed.ResultsA total of 13 trials met our selection criteria. Long-term (with at least a 1-year follow-up) mortality was significantly lower in the revascularization arm [relative risk (RR) = 0.66; 95% CI = 0.60–0.72] by either PCI (RR = 0.61; 95% CI = 0.55–0.68) or CABG (RR = 0.62; 95% CI = 0.46–0.84). The results were consistent in dialysis patients (RR = 0.68; 95% CI = 0.59–0.79), patients with stable CAD (RR = 0.75; 95% CI = 0.61–0.92), patients with acute coronary syndrome (RR = 0.62; 95% CI = 0.58–0.66), and geriatric patients (RR = 0.57; 95% CI = 0.54–0.61).ConclusionIn patients with CKD and CAD, revascularization is more effective in reducing mortality than MT alone. This observed benefit is consistent in patients with stable CAD and elderly patients. However, future randomized controlled trials (RCTs) are required to confirm these findings.
Highlights
As one of the major cardiovascular diseases affecting the global human population, coronary artery disease (CAD) is the major cause of death in both developed and developing countries [1]
The overall risk of bias was considered low in two randomized controlled trials (RCTs), and the quality evaluation of non-RCTs based on the Newcastle–Ottawa scale found that all scores were ≥ 6 (Supplementary Table S2 in the supplemental material)
Fewer patients enrolled in the trials took statins, the benefits of which have been increasingly stressed by many researchers in recent decades [19]
Summary
As one of the major cardiovascular diseases affecting the global human population, coronary artery disease (CAD) is the major cause of death in both developed and developing countries [1]. Chronic kidney disease (CKD), an independent and strong CAD risk factor, exerts great coronary artery implications and indicates higher mortality [2]. Patients with CKD were excluded from most trials, and only 10 to 40% of patients with CKD and CAD undergo revascularization in clinical practice owing to concerns about acute renal injury and major bleeding events after revascularization [3]. This population [especially regarding advanced CKD and/or end-stage kidney disease (ESKD)] is underrepresented and management is still mainly extrapolated from non-CKD cohorts [4, 5]. The optimal treatment for the patients with two coexisting diseases is still not well defined
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