Left Main Revascularization in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Cardiology Reviews Pub Date : 2025-09-17 DOI:10.2174/011573403X396917250910215747

Ioannis Gialamas, Konstantinos Kalogeras, Panteleimon Pantelidis, Georgios E Zakynthinos, Antonios Lysandrou, Efstratios Katsianos, Athina Goliopoulou, Maria Ioanna Gounaridi, Nikolaos Vythoulkas-Biotis, Ourania Katsarou, Evangelos Oikonomou, Gerasimos Siasos, Manolis Vavuranakis

{"title":"Left Main Revascularization in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis.","authors":"Ioannis Gialamas, Konstantinos Kalogeras, Panteleimon Pantelidis, Georgios E Zakynthinos, Antonios Lysandrou, Efstratios Katsianos, Athina Goliopoulou, Maria Ioanna Gounaridi, Nikolaos Vythoulkas-Biotis, Ourania Katsarou, Evangelos Oikonomou, Gerasimos Siasos, Manolis Vavuranakis","doi":"10.2174/011573403X396917250910215747","DOIUrl":null,"url":null,"abstract":"Introduction/objective: This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).Methods: A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.Results: Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,475 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75; 95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI 2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI 0.35-2.41).Discussion: While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, myocardial infarction, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.Conclusion: CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.","PeriodicalId":10832,"journal":{"name":"Current Cardiology Reviews","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Cardiology Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2174/011573403X396917250910215747","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction/objective: This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).

Methods: A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.

Results: Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,475 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75; 95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI 2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI 0.35-2.41).

Discussion: While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, myocardial infarction, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.

Conclusion: CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.

查看原文本刊更多论文

慢性肾脏疾病患者左主干血运重建术：系统回顾和荟萃分析

简介/目的：本系统综述和荟萃分析比较了经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）作为左主干冠状动脉疾病（LMCAD）和慢性肾脏疾病（CKD）患者的血运重建策略。方法：综合检索PubMed、Embase和CENTRAL，并在PROSPERO （ID: CRD42024496529）上注册预注册研究方案。主要终点是主要心脑血管不良事件（MACCE），包括全因死亡率、心肌梗死（MI）、中风或缺血驱动的血运重建。次要终点包括MACCE的各个组成部分和30天全因死亡率。结果：共分析7项研究，包括5项队列研究和2项随机临床试验亚组分析，共纳入3475例患者。PCI与MACCE的高发生率相关（风险比[HR]: 1.50； 95%可信区间[CI] 1.26-1.79），由全因死亡率（HR: 1.38; 95% CI 1.07-1.78）、心肌梗死（HR: 1.75; 95% CI 1.17-2.62）和缺血驱动的血运重建（HR: 3.22; 95% CI 2.10-4.93）驱动。卒中发生率（HR: 0.70; 95% CI 0.40-1.22）或30天全因死亡率（优势比[or]: 0.92; 95% CI 0.35-2.41）无差异。讨论：虽然先前的研究报告了关于LMCAD患者PCI与CABG非效性的相互矛盾的证据，但我们的综合分析表明PCI组MACCE发生率增加，主要是由更高的全因死亡率、心肌梗死和缺血驱动的血运重建率引起的。研究结果表明，CKD可能在多血管疾病的临床结果中发挥与糖尿病相当的作用，并且应该是决定血运重建的关键因素。结论：与LMCAD和CKD患者的PCI相比，CABG具有更好的长期预后。然而，根据CKD分期进行专门的随机对照试验对于指导这一高危人群的最佳治疗策略至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Current Cardiology Reviews CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.70

自引率

10.50%

发文量

117

期刊介绍： Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.