Percutaneous coronary intervention compared with coronary artery bypass graft in coronary artery disease patients with chronic kidney disease: a systematic review and meta-analysis

Figures & data

Figure 1. Flow chart of studies selection.

Table 1. Characteristics of the studies included in the meta-analysis.

				Follow-up
Study	Study type	Intervention	Recruited year	Short-term	Long-term	Sample size	Male	Age	Dialysis duration
Takeshita 1992 (JPN)43	Retrospective	PTCA/CABG	1983–1989	In-hospital	Mean of 35 months	15/10	21 in all	57	Mean of 3.7 years
Rinehart 1995 (US)42	Retrospective	PTCA/CABG	1977–1991	30 days	Mean of 30.7/19.6 months	24/60	14/46	63.6/62.1	Mean of 31.4/15.8 months
Koyanagi 1996 (JPN)41	Retrospective	PTCA/CABG	1984–1992	In-hospital	Mean of 2.4/2.2 years	20/23	16/22	57/55	Mean of 4.2/4.7 years
Simsir 1998 (US)40	Retrospective	PTCA/CABG	1992–1996	30 days	Mean of 22/19 months	19/22	10/11	64/64	Mean of 41/26 months
Herzog 1999 (US)39	Retrospective	PTCA/CABG	1978–1995	In-hospital	Mean of 1.59/1.88 years	6887/7419	3845/4895	–	–
Ohmoto 1999 (JPN)38	Retrospective	PTCA/CABG	1983–1997	In-hospital	Mean of 38.2/51.3 months	92/47	75/37	61/60	Mean of 51/52 months
Agirbasli 2000 (US)37	Retrospective	PTCA/CABG	1987–1997	In-hospital	1 year	122/130	78/84	58/60	–
Chertow 2000 (US)36	Retrospective	PTCA/CABG	1994–1995	30 days	1 year	46/29	28/21	–	–
Ivens 2001 (GER)35	Retrospective	PTCA/CABG	1982–1994	30 days	24 months	40/65	29/54	53/57	Mean of 33/41 months
Szczech 2001 (US)34	Retrospective	PTCA/CABG	1993–1995	–	3 years	163/244	264 in all	61.1	–
Baldovinos 2002 (ESP)33	Retrospective	PTCA/CABG	1994–1999	30 days	24 months	28/23	–	63	Median of 6 years
Herzog 2002 (US)32	Retrospective	PTCA, Stent/CABG	1995–1998	In-hospital	Mean of 18.3, 13.3^a/17.6 months	9116/6668	4905/4150	–	–
Szczech 2002 (US)31	Subgroup of BARI	PTCA/CABG	1988–1991	In-hospital	7 years	45/31	56 in all	64.2	–
Aoki 2003 (JPN)30	Retrospective	PTCA, Stent/CABG	1997–2001	In-hospital	Mean of 20/22 months	70/55	51/48	65/60	About 60.3/45 months
Hemmelgarn 2004 (CAN)21	Prospective	PCI/CABG	1995–2001	–	1.9-2.1 years	363/372	262/291	–	–
						147/153^c	109/111	47.6/48.4	–
Aoki 2005 (Allied)8	Subgroup of ARTS	Stent/CABG	1997–1998	–	5 years	69/73	44/53	70/71	–
Ix 2005 (Allied)20	Subgroup of ARTS	Stent/CABG	1997–1998	–	3 years	151/139	86/78	68/69	–
Charytan 2006 (US)19	Cross-section	PCI/CABG	2001	In-hospital	–	1552/952	–	–	–
						322/130^c	–	–	–
Fujimoto 2007 (JPN)29	Retrospective	PCI/CABG	–	In-hospital	5 years	81/64	–	–	–
Lopes 2009 (BRA)28	Subgroup of MASS II	PCI/CABG	1995–2000	–	5 years	49/46	–	–	–
Manabe 2009 (JPN)27	Retrospective	PTCA, Stent/CABG	2004–2007	In-hospital	Mean of 1.48/1.29 years	18/28	17/23	61.2/63.9	Mean of 6/6.3 years
Na 2009 (KOR)^26d	Retrospective	DES, BMS/CABG	2003–2006	–	Mean of 11 months	401(312)/101	–	–	–
Wang 2009 (CHN)25	Retrospective	DES/CABG	2004–2006	–	2 years	724/345	486/240	About 60.8/58.8	–
Ashrith 2010 (US)18	Retrospective	DES/CABG	2003–2006	30 days	About 800 days	517/295	301/178	–	–
						33/54^c	10/16	–	–
Sunagawa 2010 (JPN)17	Retrospective	DES/CABG	2002–2006	30 days	Mean of 24/32 months	75/29	55/25	65.2/62.9	–
Chang 2012 (US)7	Retrospective	Stent/CABG	1997–2009	–	Median of 1.7 years	7665/14,136	4323/9005	64.9/63.1	Median of 2.6/2.7 years
Charytan 2012 (US)11	Retrospective	PTCA, DES, BMS/CABG	2001–2007	In-hospital	3 years	8620/4547	4838/3028	–	–
Terazawa 2012 (JPN)9	Retrospective	DES/CABG	2004–2007	30 days	Mean of 39/34.1 months	67/58	51/45	63.6/65	Mean of 6.9/7.3 years
Yeates 2012 (AUS)24	Prospective	PTCA, Stent/CABG	1999–2009	30 days	Median of 24.9 months	31/24	21/14	About 61/60	Median of 11/13 months
Chang 2013 (US)6	Retrospective	PCI/CABG	1996–2008	–	Median of 3.8/3.9 years	1458/1458	1009/1009	About 72.6/72.6	–
Shroff 2013 (US)10^d	Retrospective	DES, BMS/CABG	2004–2009	30 days	Median of 1.6, 0.99^b/1.63 years	16,855(11,844)/6178	9346(6455)/3847	–	–

Notes: PTCA: percutaneous transluminal coronary angioplasty; CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention; DES: drug-eluting stent; BMS: bare-metal stent. All data are expressed by numbers as PCI/CABG in the table.

^aData of PTCA and stent group respectively.

^bData of DES and BMS group respectively.

^cData of dialysis patients.

^dData in the parentheses indicate the numbers of DES subgroup.

Table 2. Clinical outcomes of the studies included in the meta-analysis.

	Short-term outcome	Long-term outcome
Study	All-cause death	All-cause death	MI	Revascularization
Takeshita 1992 (JPN)43	0/2	2/3	–	5/1
Rinehart 1995 (US)42	1/2	12/32	5/7	–
Koyanagi 1996 (JPN)41	0/0	2/4	2/2	15/3
Simsir 1998 (US)40	1/1	6/7	–	9/1
Herzog 1999 (US)39	371/930	5289/5453	2210/1536	–
Ohmoto 1999 (JPN)38	1/7	35/16	14/6	59/15
Agirbasli 2000 (US)37	2/9	28/35	6/4	29/3
Chertow 2000 (US)36	8/5	21/9	–	–
Ivens 2001 (GER)35	0/3	7/9	4/6	23/2
Szczech 2001 (US)34	–	75/92	–	–
Baldovinos 2002 (ESP)33	6/3	9/4	10/1	–
Herzog 2002 (US)32	485/573	4713/2907	–	–
Szczech 2002 (US)31	3/1	–	–	–
Aoki 2003 (JPN)30	3/3	19/14	11/2	34/7
Hemmelgarn 2004 (CAN)21	–	224/232	–	–
	–^a	76/93	–	–
Aoki 2005 (Allied)8	–	10/9	6/8	20/7
Ix 2005 (Allied)20	–	10/9	9/11	38/11
Charytan 2006 (US)19	145/121	–	–	–
	22/23^a	–	–	–
Fujimoto 2007 (JPN)29	0/9	27/35	2/1	48/11
Lopes 2009 (BRA)28	–	9/10	–	–
Manabe 2009 (JPN)27	0/0	3/2	0/0	7/1
Na 2009 (KOR)26^b	–	35(17)/5	13(5)/5	42(35)/8
Wang 2009 (CHN)25	–	34/12	37/13	65/14
Ashrith 2010 (US)18	12/14	82/52	–	–
	1/3^a	13/16	–	–
Sunagawa 2010 (JPN)17	3/1	28/6	–	36/2
Chang 2012 (US)7	–	5378/10,154	2017/2624	–
Charytan 2012 (US)11	336/323	2828/1287	–	–
Terazawa 2012 (JPN)9	0/0	21/22	8/1	24/6
Yeates 2012 (AUS)24	0/3	12/14	–	3/0
Chang 2013 (US)6	–	359/325	323/117	324/84
Shroff 2013 (US)10^b	566(320)/507	10,449(7388)/3512	–	4650(3404)/773

Notes: MI: myocardial infarction; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft. All data are expressed by numbers as PCI/CABG in the table.

^aData of dialysis patients.

^bData in the parentheses indicate the numbers of drug-eluting stent subgroup.

Figure 2. (A) Short-term all-cause mortality in dependent dialysis patients. (B) Long-term all-cause mortality in dependent dialysis patients. (C) Long-term incidence of myocardial infarction in dependent dialysis patients. (D) Long-term incidence of revascularization in dependent dialysis patients.

Figure 3. (A) Long-term all-cause mortality in CKD patients with multivessel coronary disease. (B) Long-term incidence of myocardial infarction in CKD patients with multivessel coronary disease. (C) Long-term incidence of revascularization in CKD patients with multivessel coronary disease. CKD: chronic kidney disease.

Figure 4. (A) Short-term all-cause mortality in CKD patients comparing PCI with DES versus CABG. (B) Long-term all-cause mortality in CKD patients comparing PCI with DES versus CABG. (C) Long-term incidence of myocardial infarction in CKD patients comparing PCI with DES versus CABG. (D) Long-term incidence of revascularization in CKD patients comparing PCI with DES versus CABG. CKD: chronic kidney disease; PCI: percutaneous coronary intervention; DES: drug-eluting stent; CABG: coronary artery bypass graft.

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