Affiliation:
1. Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China
2. Department of Internal Medicine, The Third People's Hospital of Changzhou, Jiangsu, China
3. Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China
Abstract
Background
Drug‐eluting stents (
DES
s) and bare metal stents (
BMS
s) 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
DES
s over
BMS
s 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
DES
s versus
BMS
s 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
DES
s versus
BMS
s 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
DES
s versus
BMS
s 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
DES
s over
BMS
s for improving clinical outcomes was attenuated in randomized controlled trials.
Conclusions
The use of
DES
s 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
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine