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.

Abstract

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.

• Authors: Sahil Khera, Pedro A Villablanca, Dhaval Kolte, Tanush Gupta, Mohammed Hasan Khan, Poonam Velagapudi, Ankur Kalra, Neal Kleiman, Herbert D Aronow, J Dawn Abbott, Kenneth Rosenfield, Douglas E Drachman, Sripal Bangalore, Deepak L Bhatt, Srihari S Naidu
• Journal: Cardiology in review (Cardiol Rev) 2018 Nov/Dec Vol. 26 Issue 6 Pg. 277-286 ISSN: 1538-4683 [Electronic] United States
• PMID: 30157064 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Topics

• Coronary Artery Disease (epidemiology, etiology, surgery)
• Drug-Eluting Stents
• Follow-Up Studies
• Global Health
• Humans
• Kidney Failure, Chronic (complications, therapy)
• Morbidity (trends)
• Percutaneous Coronary Intervention
• Renal Dialysis
• Survival Rate (trends)
• Time Factors