Drug-eluting compared to bare metal stents in patients with end-stage renal disease on dialysis: a meta-analysis

Vincenzo Alessandro Galiffa, Gabriele Crimi, Valeria Gritti, Valeria Scotti, Maurizio Ferrario, Alessandra Repetto, Marco Ferlini, Barbara Marinoni, Gaetano Maria De Ferrari, Stefano De Servi, Angelo Sante Bongo, Luigi Oltrona Visconti, Catherine Klersy

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS: To systematically review literature comparing bare metal stent (BMS) to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on dialysis. ESRD patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stent-related complications including major adverse cardiovascular events. Because dialysis usually qualifies ineligibility for randomized clinical trials, an evidenced-based stent choice for these patients is scarce. METHODS: PUBMED, CINHAL, COCHRANE, EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES outcome in ESRD patients on dialysis. RESULTS: Twenty studies including 64 232 patients were considered. The use of DES was significantly associated with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.76-0.89], death from a cardiovascular cause (OR 0.80, 95% CI 0.76-0.84) and target lesion revascularization/target vessel revascularization (OR 0.73, 95% CI 0.53-1.00). No significant difference was found in stent thrombosis (OR 1.08, 95% CI 0.50-2.33) and myocardial infarction incidence (OR 0.91, 95% CI 0.69-1.20). CONCLUSIONS: Our meta-analysis shows a significant reduction in all-cause and cardiovascular mortality with the use of DES over BMS in dialyzed patients. Despite the lack of randomized studies, systematic use of DES in these high-risk patients should thus reasonably be considered as a first option in percutaneous coronary intervention candidates.

Original languageEnglish
Pages (from-to)313-320
Number of pages8
JournalJournal of cardiovascular medicine (Hagerstown, Md.)
Volume20
Issue number5
DOIs
Publication statusPublished - May 1 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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