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Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease.

Research paper by Alexander A Volodarskiy, Sunil S Kumar, Shyam S Amin, Sripal S Bangalore

Indexed on: 01 Aug '16Published on: 01 Aug '16Published in: The American Journal of Medicine®



Abstract

Chronic kidney disease is an independent risk factor for coronary artery disease and is associated with an increase in adverse outcomes. However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined.MEDLINE, EMBASE and CENTRAL were searched for studies including at least 100 patients with chronic kidney disease (defined as estimated glomerular filtration rate ≤ 60 mL/min/1.73 m(2) or on dialysis) and coronary artery disease treated with medical therapy, percutaneous coronary intervention or coronary artery bypass surgery and followed for at least 1 month and reporting outcomes. The outcome evaluated was all-cause mortality. Meta-analysis was performed to evaluate the outcomes with revascularization (percutaneous coronary intervention or coronary artery bypass surgery) when compared with medical therapy alone. In addition, outcomes with percutaneous coronary intervention vs. coronary artery bypass surgery were evaluated.The search yielded 38 non-randomized studies that enrolled 85,731 patients. Revascularization (percutaneous coronary intervention or coronary artery bypass surgery) was associated with lower long-term mortality (mean 4.0 years) when compared with medical therapy alone (RR=0.73; 95% CI 0.62-0.87), driven by lower mortality with percutaneous coronary intervention vs. medical therapy and coronary artery bypass surgery vs. medical therapy. Coronary artery bypass surgery was associated with a higher upfront risk of death (RR=1.81; 95% CI 1.47-2.24) but a lower long-term risk of death (RR=0.94; 95% CI 0.89-0.98) when compared to percutaneous coronary intervention.In chronic kidney disease patients with coronary artery disease, the current data from non-randomized studies indicate lower mortality with revascularization, via either coronary artery bypass surgery or percutaneous coronary intervention, when compared with medical therapy. These associations should be tested in future randomized trials.

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