Key result
An initial invasive strategy compared with conservative medical management did not reduce the risk of death or nonfatal myocardial infarction in patients with advanced CKD and stable angina.
Why the study?
Data on the evaluation and management of CAD or stable angina are limited in advanced CKD patients, with sparse data supporting either PCI or CABG.
Does an initial invasive strategy reduce the risk of death or nonfatal myocardial infarction compared to a conservative strategy in patients with advanced CKD and stable angina?
Does an initial invasive strategy reduce the risk of death or nonfatal myocardial infarction compared to a conservative strategy in patients with advanced CKD and stable angina?
In patients with advanced CKD and stable angina, an initial invasive strategy does not offer a survival or MI-reduction benefit over maximal medical therapy.
Does not support initial invasive strategy in advanced CKD with stable angina; leaves open optimal management via dedicated trials.
PURPOSE OF REVIEW: Chronic kidney disease is one of the major risk factors for coronary artery disease. Both end-stage renal disease (ESRD) and advanced chronic kidney disease patients have atypical presentations of coronary artery disease (CAD) due to modifications in cardinal symptoms and clinical presentation. Data on evaluation and management of coronary artery or stable angina is limited in advanced chronic kidney disease (CKD) patients due to a limited number of trials. There are sparse data supporting either percutaneous coronary intervention (PCI) or coronary artery bypass graft in advanced CKD patients. RECENT FINDINGS: The ISCHEMIA-CKD trial to date is the most extensive prospective randomized study looking at advanced CKD patients study looking at advanced CKD stage 4/5 patients randomized to medical treatment alone vs. invasive strategy for moderate to severe myocardial ischemia. There was no evidence found that an initial invasive strategy compared with conservative strategy with maximal medical management resulted in reduced risk of death or nonfatal myocardial infarction in patients with advanced CKD and coronary artery disease with stable angina. SUMMARY: In this review, we will discuss the existing data on assessment and management of stable coronary artery disease/stable angina. And how this extrapolates to the application in advanced CKD patients awaiting kidney transplant.
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Arif et al. (2021) conducted a review in Advanced chronic kidney disease and stable angina. Invasive strategy vs. Conservative strategy with maximal medical management was evaluated on Death or nonfatal myocardial infarction. An initial invasive strategy compared with conservative medical management did not reduce the risk of death or nonfatal myocardial infarction in patients with advanced CKD and stable angina.
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