Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis
BackgroundDrug‐eluting stents (DESs) and bare metal stents (BMSs) 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 DESs over BMSs for reducing the incidence of long‐ter...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003990 |
| _version_ | 1811334040884609024 |
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| author | Renjie Lu Fenglei Tang Yan Zhang Xishan Zhu Shanmei Zhu Ganlin Wang Yinfeng Jiang Zhengda Fan |
| author_facet | Renjie Lu Fenglei Tang Yan Zhang Xishan Zhu Shanmei Zhu Ganlin Wang Yinfeng Jiang Zhengda Fan |
| author_sort | Renjie Lu |
| collection | DOAJ |
| description | BackgroundDrug‐eluting stents (DESs) and bare metal stents (BMSs) 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 DESs over BMSs 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 DESs versus BMSs in CKD patients. Methods and ResultsIn 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 DESs versus BMSs 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 DESs versus BMSs 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 DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials. ConclusionsThe use of DESs 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. |
| first_indexed | 2024-04-13T17:01:51Z |
| format | Article |
| id | doaj.art-dd388c896c684717a5a66bf06c11d72f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:01:51Z |
| publishDate | 2016-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-dd388c896c684717a5a66bf06c11d72f2022-12-22T02:38:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-10-0151110.1161/JAHA.116.003990Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐AnalysisRenjie Lu0Fenglei Tang1Yan Zhang2Xishan Zhu3Shanmei Zhu4Ganlin Wang5Yinfeng Jiang6Zhengda Fan7Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Internal Medicine, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, ChinaDepartment of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, ChinaBackgroundDrug‐eluting stents (DESs) and bare metal stents (BMSs) 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 DESs over BMSs 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 DESs versus BMSs in CKD patients. Methods and ResultsIn 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 DESs versus BMSs 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 DESs versus BMSs 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 DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials. ConclusionsThe use of DESs 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.https://www.ahajournals.org/doi/10.1161/JAHA.116.003990bare metal stentcardiaccardiac biomarkerschronic kidney diseasecoronary diseasedialysis |
| spellingShingle | Renjie Lu Fenglei Tang Yan Zhang Xishan Zhu Shanmei Zhu Ganlin Wang Yinfeng Jiang Zhengda Fan Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bare metal stent cardiac cardiac biomarkers chronic kidney disease coronary disease dialysis |
| title | Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis |
| title_full | Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis |
| title_fullStr | Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis |
| title_full_unstemmed | Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis |
| title_short | Comparison of Drug‐Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta‐Analysis |
| title_sort | comparison of drug eluting and bare metal stents in patients with chronic kidney disease an updated systematic review and meta analysis |
| topic | bare metal stent cardiac cardiac biomarkers chronic kidney disease coronary disease dialysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003990 |
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