Percutaneous coronary intervention versus coronary artery bypass graft surgery in dialysis-dependent patients: A pooled meta-analysis of reconstructed time-to-event data

Panagiotis T Tasoudis; Dimitrios N Varvoglis; Andreas Tzoumas; Ilias P Doulamis; Aspasia Tzani; Michel Pompeu Sá; Polydoros N Kampaktsis; Michele Gallo

doi:10.1111/jocs.16805

Percutaneous coronary intervention versus coronary artery bypass graft surgery in dialysis-dependent patients: A pooled meta-analysis of reconstructed time-to-event data

J Card Surg. 2022 Oct;37(10):3365-3373. doi: 10.1111/jocs.16805. Epub 2022 Jul 28.

Authors

Panagiotis T Tasoudis¹, Dimitrios N Varvoglis¹, Andreas Tzoumas², Ilias P Doulamis³, Aspasia Tzani⁴, Michel Pompeu Sá⁵, Polydoros N Kampaktsis⁶, Michele Gallo⁷

Affiliations

¹ Department of Cardiothoracic Surgery, School of Health Sciences, University of Thessaly, Larisa, Greece.
² Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
⁶ Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, New York, USA.
⁷ Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland.

PMID: 35900307
DOI: 10.1111/jocs.16805

Abstract

Objective: Το perform a systematic review with meta-analysis of published data comparing outcomes between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in dialysis-dependent patients.

Methods: We searched PubMed, Scopus, and Cochrane databases for studies including dialysis-dependent patients who underwent either CABG or PCI. This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We conducted one-stage and two-stage meta-analysis with Kaplan-Meier-derived individual patient data for overall survival and meta-analysis with the random-effects model for the in-hospital mortality and repeat revascularization.

Results: Twelve studies met our eligibility criteria, including 13,651 and 28,493 patients were identified in the CABG and PCI arms, respectively. Patients who underwent CABG had overall improved survival compared with those who underwent PCI at the one-stage meta-analysis (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.09-1.16, p < .0001) and the two-stage meta-analysis (HR: 1.15, 95% CI: 1.08-1.23, p < .001, I² = 30.0%). Landmark analysis suggested that PCI offers better survival before the 8.5 months of follow-up (HR: 0.96, 95% CI: 0.92-0.99, p = .043), while CABG offers an advantage after this timepoint (HR: 1.3, 95% CI: 1.22-1.32, p < .001). CABG was associated with increased odds for in-hospital mortality (odds ratio [OR]: 1.70, 95% CI: 1.50-1.92, p < .001, I² = 0.0%) and decreased odds for repeat revascularization (OR: 0.22, 95% CI: 0.14-0.34, p < .001, I² = 58.08%).

Conclusions: In dialysis-dependent patients, CABG was associated with long-term survival but a higher risk for early mortality. The risk for repeat revascularization was higher with PCI.

Keywords: cardiac surgical procedures; cardiovascular surgical procedures; coronary artery bypass; myocardial revascularization; percutaneous coronary intervention.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Coronary Artery Bypass
Coronary Artery Disease* / surgery
Drug-Eluting Stents*
Humans
Percutaneous Coronary Intervention*
Renal Dialysis
Treatment Outcome