Meta-analysis Of Drug-eluting And Bare-metal Stents For Treating The Patients With Chronic Kidney Disease And Coronary Artery Disease

Objective:To systematically review the safety and efficacy of drug-eluting stents(DES)and bare-metal stents(BMS)for treatment of coronary Artery disease with chronic kidney disease.Methods:Electronic database Pub Med,Embase?The Cochrane Library Cochrane Library,VIP,CNKI,CBM,Wan fang were searched to collect nearly 10 years controlled trials that included randomized controlled trials and observational studies about DES versus BMS during PCI in Patients with chronic kidney disease.The study included at least 100 CKD patients treated with DES or BMS(estimated glomerular filtration rate ? 60 ml/min/1.73 m2 or dialysis status).All studies were followed for at least 1year and all-cause mortality,myocardial infarction(MI),target lesions and target vessel revascularization(TLR/TVR)were reported.The quality of literatures were assessed according to the Newcastle-Ottawa Scale(NOS)and analysis was conducted by Rev Man 5.3 software.Result:Finally,13 studies involving 43400 patients were included.In general,DES-treated patients demonstrate a lower risk of the clinical adverse events compared with those treated with BMS.Among the 12 trial data,combined analysis showed that all-cause mortality was significantly reduced in patients treated with DES compared with those treated with BMS(0R=0.72,95% CI: 0.69-0.76,P<0.001),and 8 trial data were collected,the incidence of major adverse cardiac events(MACE)showed a decrease in patients receiving DES(OR=0.69,95% CI: 0.61 to 0.79,P<0.001),11 trials Statistical analysis showed that the rate of target lesions and target vessel revascularization(TLR/TVR)was reduced in patients receiving DES implantation(OR=0.81,95% CI: 0.71 to 0.92,P=0.002),while myocardial infarction(MI)had no difference of statistical significance(OR=0.94,95% CI: 0.88 to 1.01,P=0.09).Conclusion:In patients with CKD,the meta-analysis shows that DES implantation exhibits a favorable clinical outcome than BMS implantation from the observational studies.These findings should also be tested in large-scale randomized trials.