Outcomes with revascularization and medical therapy in patients with coronary disease and chronic kidney disease: A meta-analysis

Leszek, Alexandre; Poli, Lauriane; Zbinden, Stéphanie; Reny, Jean-Luc; Farkouh, Michael E.; Charytan, David M.; Mavrakanas, Thomas

doi:10.1016/j.atherosclerosis.2022.02.023

Cited by 8 publications

(3 citation statements)

References 51 publications

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“… 54 Still, a meta-analysis of trials comparing early coronary revascularization with optimal medical therapy versus medical therapy specifically in patients with CKD (n=3422) reported early revascularization to result in lower incidence of myocardial infarction compared with medical therapy alone (RR, 0.71 [95% CI, 0.54–0.94]; P =0.02). 55 This result was mainly driven in patients with stable CAD, suggesting a potential benefit.…”

Section: Cad and Ckdmentioning

confidence: 90%

The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

Schuett

Lehrke

2023

Circulation Research

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Patients with chronic kidney disease (CKD) are at high risk to develop cardiovascular disease with its manifestations coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. In addition, the presence of CKD has a major impact on the prognosis of patients with cardiovascular disease, leading to an increased morbidity and mortality if both comorbidities are present. Therapeutic options including medical therapy and interventional treatment are often limited in patients with advanced CKD, and in most cardiovascular outcome trials, patients with advanced CKD have been excluded. Thus, in many patients, treatment strategies for cardiovascular disease need to be extrapolated from trials conducted in patients without CKD. The current article summarizes the epidemiology, clinical presentation, and treatment options for the most prevalent manifestations of cardiovascular disease in CKD and discusses the currently available treatment options to reduce morbidity and mortality in this high-risk population.

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Section: Cad and Ckdmentioning

confidence: 90%

The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

Schuett

Lehrke

2023

Circulation Research

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“…Bonello et al [ 34 ] also showed that the rate of mortality and MI was not affected by the median time between randomization and CAG (range: 0.5–14.0 h and 18.3–86.0 h). In the subgroup analysis of the most recent meta-analysis including 3422 patients from 11 randomized trials [ 36 ], the all-cause death rate was lower in the revascularization group than in the medical therapy group in patients with NSTE-ACS and CKD (relative risk: 0.73; 95% CI: 0.51–1.04; p = 0.08). Because patients presenting with NSTEMI often have many comorbidities, including CKD [ 11 , 12 ], an early invasive strategy may worsen the outcomes in those patients, becuase the renal function can be further reduced due to contrast dye administration and sub-optimal fluid support prior to the procedure.…”

Section: Discussionmentioning

confidence: 99%

Effect of delayed hospitalization on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction

et al. 2024

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Background We evaluated the effect of delayed hospitalization (symptom-to-door time [STD] ≥ 24 h) on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing new-generation drug-eluting stent (DES) implantation. Methods A total of 4513 patients with NSTEMI were classified into chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 , n = 1118) and non-CKD (eGFR ≥ 60 mL/min/1.73 m 2 , n = 3395) groups. They were further sub-classified into groups with (STD ≥ 24 h) and without (STD < 24 h) delayed hospitalization. The primary outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, any repeat coronary revascularization, and stroke. The secondary outcome was stent thrombosis. Results After multivariable-adjusted and propensity score analyses, the primary and secondary clinical outcomes were similar in patients with or without delayed hospitalization in both CKD and non-CKD groups. However, in both the STD < 24 h and STD ≥ 24 h groups, MACCE (p < 0.001 and p < 0.006, respectively) and mortality rates were significantly higher in the CKD group than in the non-CKD group. However, stent thrombosis rates were similar between the CKD and non-CKD groups and between the STD < 24 h and STD ≥ 24 h groups. Conclusions Chronic kidney disease appears to be a much more important determinant of MACCE and mortality rates than STD in patients with NSTEMI.

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“…In fact, CKD stands out as one of the main causes of non-referral to revascularization procedures in ACS patients. Nevertheless, a comprehensive meta-analysis involving over 3000 patients revealed that revascularization, in comparison to medical therapy, entailed a lower incidence of MI in individuals with CKD [85]. Additionally, in a Spanish registry including octogenarian patients admitted for ACS, those with more severe CKD were older and showed a worse clinical profile with higher comorbidity burden and frailty.…”

Section: Comorbiditymentioning

confidence: 99%

The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review

Alonso Salinas,

Cepas-Guillén,

León

et al. 2024

JCM

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The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.

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Outcomes with revascularization and medical therapy in patients with coronary disease and chronic kidney disease: A meta-analysis

Cited by 8 publications

References 51 publications

The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

Effect of delayed hospitalization on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction

The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review

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