Long-Term Outcomes of Drug-Eluting Stents versus Bare-Metal Stents in End Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis.
Summary of "Long-Term Outcomes of Drug-Eluting Stents versus Bare-Metal Stents in End Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis."
There are no dedicated data to guide drug eluting stent (DES) versus bare metal stent (BMS) selection in patients with end stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent-type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of non-randomized studies extracted from PubMed, Scopus, and EMBASE; assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method. Random-effects model was used for all analyses. A total of 17 non-randomized studies (N=63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis; median follow-up of 1 year (range: 9 months - 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95%CI 0.64-0.89, P<0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95%CI 0.60-0.99, P=0.047) and target lesion/vessel revascularization (TLR/TVR) (OR 0.78, 95%CI 0.64-0.94, P=0.01). However, there were no differences in non-cardiovascular mortality, myocardial infarction, stent thrombosis, stroke or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes following percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, TLR/TVR, and cardiovascular death.
Affiliation
Journal Details
This article was published in the following journal.
Name: Cardiology in review
ISSN: 1538-4683
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/30157064
- DOI: http://dx.doi.org/10.1097/CRD.0000000000000192
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Medical and Biotech [MESH] Definitions
Drug-eluting Stents
Stents that are covered with materials that are embedded with chemicals that are gradually released into the surrounding milieu.
Insurance, Long-term Care
Health insurance to provide full or partial coverage for long-term home care services or for long-term nursing care provided in a residential facility such as a nursing home.
Hiv Long-term Survivors
Persons who have experienced prolonged survival of HIV infection. This includes the full spectrum of untreated, HIV-infected long-term asymptomatics to those with AIDS who have survived due to successful treatment.
Long-term Potentiation
A persistent increase in synaptic efficacy, usually induced by appropriate activation of the same synapses. The phenomenological properties of long-term potentiation suggest that it may be a cellular mechanism of learning and memory.
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Drug-related movement disorder characterized by uncontrollable movements in certain muscles. It is associated with a long-term exposure to certain neuroleptic medications (e.g., METOCLOPRAMIDE).
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