Abstract: FR-PO1038
Cardiovascular and Renal Outcomes with Percutaneous Coronary Intervention Compared with Medical Therapy in Patients with CKD: A Meta-Analysis
Session Information
- Hypertension and CVD: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Poli, Lauriane, Geneva University Hospitals, Geneva, Switzerland
- Zbinden, Stéphanie, Geneva University Hospitals, Geneva, Switzerland
- Leszek, Alexandre, Hopital Neuchatelois Pourtalès, Neuchatel, Switzerland
- Godoy, Lucas C., University of Toronto, Toronto, Ontario, Canada
- Farkouh, Michael E., University of Toronto, Toronto, Ontario, Canada
- Mavrakanas, Thomas, Geneva University Hospitals, Geneva, Switzerland
Background
The optimal management of coronary artery disease (CAD) in patients with chronic kidney disease (CKD) remains a matter of debate because these patients have been excluded from most randomized controlled trials (RCTs). The purpose of this meta-analysis was to examine whether percutaneous coronary intervention (PCI) among patients with CKD is associated with lower incidence of cardiovascular and renal outcomes compared with standard medical therapy.
Methods
A Medline literature research was conducted in PubMed for RCTs or cohort studies that compared different treatment strategies in adult patients with CAD and CKD. The primary outcome was the incidence of major adverse cardiovascular events. The secondary outcomes were progression of CKD and death from any cause. CKD was defined as an estimated glomerular filtration rate < 60ml/min/1.73m2. The risk ratio (RR) was estimated using a random effects model.
Results
Four cohort studies and one RCT were included in this meta-analysis (839 CKD patients) for the primary outcome. Compared with optimal medical therapy, PCI was not associated with lower incidence of major adverse cardiovascular events: RR 0.91, 95% confidence interval (CI) 0.70-1.18 (Figure). In addition, PCI was not associated with lower incidence of CKD progression: RR 1.20, 95% CI (0.92-1.56). However, PCI was associated with lower all-cause mortality: RR 0.70, 95% CI (0.51-0.97), compared with medical therapy.
Conclusion
PCI may be superior to medical therapy in patients with CKD and CAD. Because of high inconsistency and risk of bias of the included studies, no definite conclusions can be drawn until ongoing RCTs report.
Figure Forest plot for major adverse cardiovascular events in patients with CAD and CKD