CABG Better Than PCI in End-Stage Renal Disease
Updated review and meta-analysis show beneficial effect for CABG for long-term mortality.
(HealthDay News) -- For patients with end-stage renal disease (ESRD) referred for coronary revascularization, coronary artery bypass grafting (CABG) is associated with a small decrease in long-term mortality compared with percutaneous coronary intervention (PCI), according to a review published in The American Journal of Cardiology.
Ashok Krishnaswami, MD, from the Kaiser Permanente San Jose Medical Center in California, and colleagues performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD for the primary outcome of long-term mortality. Observational studies published after 2011 were included to ensure overlap with previous studies; 7 new studies were included for a total of 23. The median sample size was 125 patients (25 to 15,784), with large variation seen in adjustment for covariate risk.
The researchers found that CABG correlated with a small reduction in mortality (relative risk, 0.92), with considerable heterogeneity (I² = 48.6%). The summary estimate trending toward survival benefit of CABG was confirmed in subgroup analysis categorized by year of study initiation; in addition, after 2004 there was a considerable decrease in heterogeneity (I² = 0 %).
"The generalizability of the finding to all patients with ESRD referred for coronary revascularization is limited because of a lack of known indications for coronary revascularization, substantial variation in covariate risk adjustment, and lack of randomized clinical trial data," the authors write.