Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis
There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method. Random-effects model was used for all analyses. A total of 17 nonrandomized studies (N = 63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis: median follow-up of 1 year (range: 9 months to 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95% CI 0.64-0.89, P<0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95% CI 0.60-0.99, P = 0.047) and target lesion/vessel revascularization (OR 0.78, 95% CI 0.64-0.94, P = 0.01). However, there were no differences in noncardiovascular mortality, myocardial infarction, stent thrombosis, stroke, or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes after percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, target lesion/vessel revascularization, and cardiovascular death.
Khera, S., Villablanca, P., Kolte, D., Gupta, T., Khan, M., Velagapudi, P., Kalra, A., Kleiman, N., Aronow, H., Abbott, J., Rosenfield, K., Drachman, D., Bangalore, S., Bhatt, D., & Naidu, S. (2018). Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis. Cardiology in Review, 26 (6), 277-286. https://doi.org/10.1097/CRD.0000000000000192