Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stent-related complications in CKD patients, a systematic review, meta-analysis and network meta-analysis

Gabriele Crimi, Valeria Gritti, Vincenzo Alessandro Galiffa, Valeria Scotti, Sergio Leonardi, Maurizio Ferrario, Marco Ferlini, Gaetano Maria De Ferrari, Luigi Oltrona Visconti, Catherine Klersy

Research output: Contribution to journalReview article

Abstract

Aims To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES. Methods and Results PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18% lower all-cause mortality (RR 0.82, 95%CI 0.71-0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95%CI 0.67-0.91), as was stent thrombosis (ST) (RR 0.57, 95%CI 0.34-0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95%CI 0.57-0.84) and death for cardiovascular cause (RR 0.43, 95%CI 0.25-0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of -18% in of all-cause death, and lower incidence of stent-related clinical events: -39% RR of ST risk; -27 RR of TVR/TLR risk. Conclusions DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent-related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.

Original languageEnglish
Pages (from-to)319-329
Number of pages11
JournalJournal of Interventional Cardiology
Volume31
Issue number3
DOIs
Publication statusPublished - Jun 2018

Fingerprint

Drug-Eluting Stents
Chronic Renal Insufficiency
Stents
Meta-Analysis
Metals
Thrombosis
Cause of Death
Network Meta-Analysis
Risk Reduction Behavior
PubMed
Myocardial Infarction

Keywords

  • Coronary Occlusion/complications
  • Drug-Eluting Stents
  • Humans
  • Network Meta-Analysis
  • Percutaneous Coronary Intervention
  • Renal Insufficiency, Chronic/complications
  • Risk
  • Self Expandable Metallic Stents
  • Treatment Outcome

Cite this

@article{2ecf180a8a4e43af933f2db564effe51,
title = "Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stent-related complications in CKD patients, a systematic review, meta-analysis and network meta-analysis",
abstract = "Aims To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES. Methods and Results PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18{\%} lower all-cause mortality (RR 0.82, 95{\%}CI 0.71-0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95{\%}CI 0.67-0.91), as was stent thrombosis (ST) (RR 0.57, 95{\%}CI 0.34-0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95{\%}CI 0.57-0.84) and death for cardiovascular cause (RR 0.43, 95{\%}CI 0.25-0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of -18{\%} in of all-cause death, and lower incidence of stent-related clinical events: -39{\%} RR of ST risk; -27 RR of TVR/TLR risk. Conclusions DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent-related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.",
keywords = "Coronary Occlusion/complications, Drug-Eluting Stents, Humans, Network Meta-Analysis, Percutaneous Coronary Intervention, Renal Insufficiency, Chronic/complications, Risk, Self Expandable Metallic Stents, Treatment Outcome",
author = "Gabriele Crimi and Valeria Gritti and Galiffa, {Vincenzo Alessandro} and Valeria Scotti and Sergio Leonardi and Maurizio Ferrario and Marco Ferlini and {De Ferrari}, {Gaetano Maria} and {Oltrona Visconti}, Luigi and Catherine Klersy",
note = "{\circledC} 2017, Wiley Periodicals, Inc.",
year = "2018",
month = "6",
doi = "10.1111/joic.12473",
language = "English",
volume = "31",
pages = "319--329",
journal = "Journal of Interventional Cardiology",
issn = "0896-4327",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stent-related complications in CKD patients, a systematic review, meta-analysis and network meta-analysis

AU - Crimi, Gabriele

AU - Gritti, Valeria

AU - Galiffa, Vincenzo Alessandro

AU - Scotti, Valeria

AU - Leonardi, Sergio

AU - Ferrario, Maurizio

AU - Ferlini, Marco

AU - De Ferrari, Gaetano Maria

AU - Oltrona Visconti, Luigi

AU - Klersy, Catherine

N1 - © 2017, Wiley Periodicals, Inc.

PY - 2018/6

Y1 - 2018/6

N2 - Aims To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES. Methods and Results PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18% lower all-cause mortality (RR 0.82, 95%CI 0.71-0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95%CI 0.67-0.91), as was stent thrombosis (ST) (RR 0.57, 95%CI 0.34-0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95%CI 0.57-0.84) and death for cardiovascular cause (RR 0.43, 95%CI 0.25-0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of -18% in of all-cause death, and lower incidence of stent-related clinical events: -39% RR of ST risk; -27 RR of TVR/TLR risk. Conclusions DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent-related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.

AB - Aims To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES. Methods and Results PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18% lower all-cause mortality (RR 0.82, 95%CI 0.71-0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95%CI 0.67-0.91), as was stent thrombosis (ST) (RR 0.57, 95%CI 0.34-0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95%CI 0.57-0.84) and death for cardiovascular cause (RR 0.43, 95%CI 0.25-0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of -18% in of all-cause death, and lower incidence of stent-related clinical events: -39% RR of ST risk; -27 RR of TVR/TLR risk. Conclusions DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent-related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.

KW - Coronary Occlusion/complications

KW - Drug-Eluting Stents

KW - Humans

KW - Network Meta-Analysis

KW - Percutaneous Coronary Intervention

KW - Renal Insufficiency, Chronic/complications

KW - Risk

KW - Self Expandable Metallic Stents

KW - Treatment Outcome

U2 - 10.1111/joic.12473

DO - 10.1111/joic.12473

M3 - Review article

VL - 31

SP - 319

EP - 329

JO - Journal of Interventional Cardiology

JF - Journal of Interventional Cardiology

SN - 0896-4327

IS - 3

ER -