Key result
In patients with chronic kidney disease, drug-eluting stents significantly reduced major adverse cardiovascular events compared to bare metal stents (OR 0.75; 95% CI 0.64-0.88; P<0.001).
Why the study?
Does the use of drug-eluting stents reduce major adverse cardiovascular events compared to bare metal stents in patients with chronic kidney disease?
Meta-Analysis (n=123,396)
Does the use of drug-eluting stents reduce major adverse cardiovascular events compared to bare metal stents in patients with chronic kidney disease?
Odds Ratio: 0.75 (95% CI 0.64–0.88)
p-value: p=<0.001
In patients with chronic kidney disease, drug-eluting stents are associated with reduced major adverse cardiovascular events and mortality compared to bare metal stents, though this benefit appears attenuated in randomized trials.
Supports preferential drug-eluting stent use in chronic kidney disease; confirms benefit and strengthens evidence for this high-risk group.
BACKGROUND: Drug-eluting stents (DESs) and bare metal stents (BMSs) are both recommended to improve coronary revascularization and to treat coronary artery disease in patients with chronic kidney disease (CKD). However, the potential superiority of DESs over BMSs for reducing the incidence of long-term major adverse cardiovascular events and mortality in CKD patients has not been established, and the results remain controversial. We aimed to systematically assess and quantify the total weight of evidence regarding the use of DESs versus BMSs in CKD patients. METHODS AND RESULTS: In this systematic review and conventional meta-analysis, electronic studies published in any language until May 20, 2016, were systematically searched through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials and observational studies comparing outcomes in CKD patients with DESs versus BMSs and extracted data in a standard form. Pooled odd ratios and 95% CIs were calculated using random- and fixed-effects models. Finally, 38 studies involving 123 396 patients were included. The use of DESs versus BMSs was associated with significant reductions in major adverse cardiovascular events (pooled odds ratio 0.75; 95% CI, 0.64-0.88; P<0.001), all-cause mortality (odds ratio 0.81; 95% CI, 0.73-0.90; P<0.001), myocardial infarction, target-lesion revascularization, and target-vessel revascularization. The superiority of DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials. CONCLUSIONS: The use of DESs significantly improves the above outcomes in CKD patients. Nevertheless, large-sized randomized controlled trials are necessary to determine the real effect on CKD patients and whether efficacy differs by type of DES.
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Lu et al. (2016) conducted a meta-analysis in Chronic kidney disease (n=123,396). Drug-eluting stents vs. Bare metal stents was evaluated on Major adverse cardiovascular events (OR 0.75, 95% CI 0.64-0.88, p=<0.001). In patients with chronic kidney disease, drug-eluting stents significantly reduced major adverse cardiovascular events compared to bare metal stents (OR 0.75; 95% CI 0.64-0.88; P<0.001).
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