Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease
Abstract Background Chronic kidney disease is an independent risk factor for coronary artery disease and is associated with an increase in adverse outcomes. However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined. Methods M...
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| Veröffentlicht in: | The American journal of medicine 2016-12, Vol.129 (12), p.1288-1298 |
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| description | Abstract Background Chronic kidney disease is an independent risk factor for coronary artery disease and is associated with an increase in adverse outcomes. However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined. Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with chronic kidney disease (defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or on dialysis) and coronary artery disease treated with medical therapy, percutaneous coronary intervention, or coronary artery bypass surgery and followed for at least 1 month and reporting outcomes. The outcome evaluated was all-cause mortality. Meta-analysis was performed to evaluate the outcomes with revascularization (percutaneous coronary intervention or coronary artery bypass surgery) when compared with medical therapy alone. In addition, outcomes with percutaneous coronary intervention vs coronary artery bypass surgery were evaluated. Results The search yielded 38 nonrandomized studies that enrolled 85,731 patients. Revascularization (percutaneous coronary intervention or coronary artery bypass surgery) was associated with lower long-term mortality (mean 4.0 years) when compared with medical therapy alone (relative risk [RR] 0.73; 95% confidence interval [CI], 0.62-0.87), driven by lower mortality with percutaneous coronary intervention vs medical therapy and coronary artery bypass surgery vs medical therapy. Coronary artery bypass surgery was associated with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared with percutaneous coronary intervention. Conclusions In chronic kidney disease patients with coronary artery disease, the current data from nonrandomized studies indicate lower mortality with revascularization, via either coronary artery bypass surgery or percutaneous coronary intervention, when compared with medical therapy. These associations should be tested in future randomized trials. |
| doi_str_mv | 10.1016/j.amjmed.2016.06.046 |
| format | Article |
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However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined. Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with chronic kidney disease (defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or on dialysis) and coronary artery disease treated with medical therapy, percutaneous coronary intervention, or coronary artery bypass surgery and followed for at least 1 month and reporting outcomes. The outcome evaluated was all-cause mortality. Meta-analysis was performed to evaluate the outcomes with revascularization (percutaneous coronary intervention or coronary artery bypass surgery) when compared with medical therapy alone. In addition, outcomes with percutaneous coronary intervention vs coronary artery bypass surgery were evaluated. Results The search yielded 38 nonrandomized studies that enrolled 85,731 patients. Revascularization (percutaneous coronary intervention or coronary artery bypass surgery) was associated with lower long-term mortality (mean 4.0 years) when compared with medical therapy alone (relative risk [RR] 0.73; 95% confidence interval [CI], 0.62-0.87), driven by lower mortality with percutaneous coronary intervention vs medical therapy and coronary artery bypass surgery vs medical therapy. Coronary artery bypass surgery was associated with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared with percutaneous coronary intervention. Conclusions In chronic kidney disease patients with coronary artery disease, the current data from nonrandomized studies indicate lower mortality with revascularization, via either coronary artery bypass surgery or percutaneous coronary intervention, when compared with medical therapy. These associations should be tested in future randomized trials.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2016.06.046</identifier><identifier>PMID: 27476086</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiovascular disease ; Cause of Death ; Chronic kidney disease ; Comorbidity ; Coronary Artery Bypass - methods ; Coronary Artery Bypass - mortality ; Coronary Artery Bypass - statistics & numerical data ; Coronary artery bypass graft surgery ; Coronary artery disease ; Coronary Artery Disease - drug therapy ; Coronary Artery Disease - mortality ; Coronary Artery Disease - surgery ; Glomerular Filtration Rate ; Humans ; Internal Medicine ; Kidney diseases ; Medical therapy ; Medical treatment ; Mortality ; Myocardial Revascularization - methods ; Myocardial Revascularization - mortality ; Myocardial Revascularization - statistics & numerical data ; Outcome and Process Assessment (Health Care) - statistics & numerical data ; Percutaneous coronary intervention ; Percutaneous Coronary Intervention - methods ; Percutaneous Coronary Intervention - mortality ; Percutaneous Coronary Intervention - statistics & numerical data ; Renal Dialysis - statistics & numerical data ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - therapy ; Revascularization ; Surgery ; Treatment Outcome</subject><ispartof>The American journal of medicine, 2016-12, Vol.129 (12), p.1288-1298</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Dec 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-633a768241264217829fb33ee333603f55603c675a8a49130eac369239b5a9fa3</citedby><cites>FETCH-LOGICAL-c445t-633a768241264217829fb33ee333603f55603c675a8a49130eac369239b5a9fa3</cites><orcidid>0000-0003-4420-5000 ; 0000-0001-9485-0652</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002934316307343$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27476086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Volodarskiy, Alexander, MD</creatorcontrib><creatorcontrib>Kumar, Sunil, MD</creatorcontrib><creatorcontrib>Amin, Shyam, MD</creatorcontrib><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><title>Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background Chronic kidney disease is an independent risk factor for coronary artery disease and is associated with an increase in adverse outcomes. However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined. Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with chronic kidney disease (defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or on dialysis) and coronary artery disease treated with medical therapy, percutaneous coronary intervention, or coronary artery bypass surgery and followed for at least 1 month and reporting outcomes. The outcome evaluated was all-cause mortality. Meta-analysis was performed to evaluate the outcomes with revascularization (percutaneous coronary intervention or coronary artery bypass surgery) when compared with medical therapy alone. In addition, outcomes with percutaneous coronary intervention vs coronary artery bypass surgery were evaluated. Results The search yielded 38 nonrandomized studies that enrolled 85,731 patients. Revascularization (percutaneous coronary intervention or coronary artery bypass surgery) was associated with lower long-term mortality (mean 4.0 years) when compared with medical therapy alone (relative risk [RR] 0.73; 95% confidence interval [CI], 0.62-0.87), driven by lower mortality with percutaneous coronary intervention vs medical therapy and coronary artery bypass surgery vs medical therapy. Coronary artery bypass surgery was associated with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared with percutaneous coronary intervention. Conclusions In chronic kidney disease patients with coronary artery disease, the current data from nonrandomized studies indicate lower mortality with revascularization, via either coronary artery bypass surgery or percutaneous coronary intervention, when compared with medical therapy. These associations should be tested in future randomized trials.</description><subject>Cardiovascular disease</subject><subject>Cause of Death</subject><subject>Chronic kidney disease</subject><subject>Comorbidity</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Coronary Artery Bypass - statistics & numerical data</subject><subject>Coronary artery bypass graft surgery</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - surgery</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Kidney diseases</subject><subject>Medical therapy</subject><subject>Medical treatment</subject><subject>Mortality</subject><subject>Myocardial Revascularization - methods</subject><subject>Myocardial Revascularization - mortality</subject><subject>Myocardial Revascularization - statistics & numerical data</subject><subject>Outcome and Process Assessment (Health Care) - statistics & numerical data</subject><subject>Percutaneous coronary intervention</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Percutaneous Coronary Intervention - statistics & numerical data</subject><subject>Renal Dialysis - statistics & numerical data</subject><subject>Renal Insufficiency, Chronic - mortality</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>Revascularization</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUtuKFDEQDaK44-gfiAR88aXH3NP9IizjFRdW2PU5ZtLVbtq-jElGmb-3mtlV2BehSFGpU1XJOUXIc842nHHzut_4sR-h3QiMNgxNmQdkxbXWleVGPCQrxpioGqnkGXmSc48ha7R5TM6EVdaw2qzIt8t9iaMf6HUCX0aYCr0qyRf4HiHTONEvvkS8zfR3LDd0e5PmKQb6ObYTHOnbmMFnoH5q6XbGlE9Hep4KpL-5p-RR54cMz279mnx9_-56-7G6uPzwaXt-UQWldKmMlN6aWigujBLc1qLpdlICSCkNk53WeAZjta-9arhk4IM0jZDNTvum83JNXp367tP88wC5uDHmAMPgJ5gP2fFaGCtrri1CX96D9vMhTfg6RGnRKGVwwpqoEyqkOecEndsnZCodHWduUcD17qSAWxRwDE0ZLHtx2_ywW3J3RXeUI-DNCQDIxq8IyeWADAdoY4JQXDvH_0243yAMEUXxww84Qv73F5eFY-5q2YJlCbiRzKKXfwAGu6uq</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Volodarskiy, Alexander, MD</creator><creator>Kumar, Sunil, MD</creator><creator>Amin, Shyam, MD</creator><creator>Bangalore, Sripal, MD, MHA</creator><general>Elsevier Inc</general><general>Elsevier Sequoia S.A</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4420-5000</orcidid><orcidid>https://orcid.org/0000-0001-9485-0652</orcidid></search><sort><creationdate>20161201</creationdate><title>Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease</title><author>Volodarskiy, Alexander, MD ; Kumar, Sunil, MD ; Amin, Shyam, MD ; Bangalore, Sripal, MD, MHA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-633a768241264217829fb33ee333603f55603c675a8a49130eac369239b5a9fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Cardiovascular disease</topic><topic>Cause of Death</topic><topic>Chronic kidney disease</topic><topic>Comorbidity</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary Artery Bypass - mortality</topic><topic>Coronary Artery Bypass - statistics & numerical data</topic><topic>Coronary artery bypass graft surgery</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - drug therapy</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - surgery</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Kidney diseases</topic><topic>Medical therapy</topic><topic>Medical treatment</topic><topic>Mortality</topic><topic>Myocardial Revascularization - methods</topic><topic>Myocardial Revascularization - mortality</topic><topic>Myocardial Revascularization - statistics & numerical data</topic><topic>Outcome and Process Assessment (Health Care) - statistics & numerical data</topic><topic>Percutaneous coronary intervention</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Percutaneous Coronary Intervention - statistics & numerical data</topic><topic>Renal Dialysis - statistics & numerical data</topic><topic>Renal Insufficiency, Chronic - mortality</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>Revascularization</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Volodarskiy, Alexander, MD</creatorcontrib><creatorcontrib>Kumar, Sunil, MD</creatorcontrib><creatorcontrib>Amin, Shyam, MD</creatorcontrib><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Volodarskiy, Alexander, MD</au><au>Kumar, Sunil, MD</au><au>Amin, Shyam, MD</au><au>Bangalore, Sripal, MD, MHA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>129</volume><issue>12</issue><spage>1288</spage><epage>1298</epage><pages>1288-1298</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background Chronic kidney disease is an independent risk factor for coronary artery disease and is associated with an increase in adverse outcomes. However, the optimal treatment strategies for patients with chronic kidney disease and coronary artery disease are yet to be defined. Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with chronic kidney disease (defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or on dialysis) and coronary artery disease treated with medical therapy, percutaneous coronary intervention, or coronary artery bypass surgery and followed for at least 1 month and reporting outcomes. The outcome evaluated was all-cause mortality. Meta-analysis was performed to evaluate the outcomes with revascularization (percutaneous coronary intervention or coronary artery bypass surgery) when compared with medical therapy alone. In addition, outcomes with percutaneous coronary intervention vs coronary artery bypass surgery were evaluated. Results The search yielded 38 nonrandomized studies that enrolled 85,731 patients. Revascularization (percutaneous coronary intervention or coronary artery bypass surgery) was associated with lower long-term mortality (mean 4.0 years) when compared with medical therapy alone (relative risk [RR] 0.73; 95% confidence interval [CI], 0.62-0.87), driven by lower mortality with percutaneous coronary intervention vs medical therapy and coronary artery bypass surgery vs medical therapy. Coronary artery bypass surgery was associated with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared with percutaneous coronary intervention. Conclusions In chronic kidney disease patients with coronary artery disease, the current data from nonrandomized studies indicate lower mortality with revascularization, via either coronary artery bypass surgery or percutaneous coronary intervention, when compared with medical therapy. These associations should be tested in future randomized trials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27476086</pmid><doi>10.1016/j.amjmed.2016.06.046</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4420-5000</orcidid><orcidid>https://orcid.org/0000-0001-9485-0652</orcidid></addata></record> |
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| subjects | Cardiovascular disease Cause of Death Chronic kidney disease Comorbidity Coronary Artery Bypass - methods Coronary Artery Bypass - mortality Coronary Artery Bypass - statistics & numerical data Coronary artery bypass graft surgery Coronary artery disease Coronary Artery Disease - drug therapy Coronary Artery Disease - mortality Coronary Artery Disease - surgery Glomerular Filtration Rate Humans Internal Medicine Kidney diseases Medical therapy Medical treatment Mortality Myocardial Revascularization - methods Myocardial Revascularization - mortality Myocardial Revascularization - statistics & numerical data Outcome and Process Assessment (Health Care) - statistics & numerical data Percutaneous coronary intervention Percutaneous Coronary Intervention - methods Percutaneous Coronary Intervention - mortality Percutaneous Coronary Intervention - statistics & numerical data Renal Dialysis - statistics & numerical data Renal Insufficiency, Chronic - mortality Renal Insufficiency, Chronic - therapy Revascularization Surgery Treatment Outcome |
| title | Optimal Treatment Strategies in Patients with Chronic Kidney Disease and Coronary Artery Disease |
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