scholarly journals Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199027
Author(s):  
Kongyong Cui ◽  
Hong Liu ◽  
Fei Yuan ◽  
Feng Xu ◽  
Min Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Repeat Revascularization ◽  
Artery Disease

Background: The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. Methods: Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. Results: Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74–0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27–0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16–0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00–1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37–2.25) (>3 years). Conclusion: This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

18F-sodium fluoride coronary uptake in patients with coronary artery bypass grafts

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kwiecinski ◽  
E Tzolos ◽  
S Cadet ◽  
P.D Adamson ◽  
N Joshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Bypass Grafts ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease ◽  
Cabg Patients

Abstract   18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of active calcification (microcalcification) across a wide range of cardiovascular conditions including coronary artery disease, carotid and penile atherosclerosis, aortic and mitral valve disease, and abdominal aortic aneurysms. To date the significance of 18F-NaF uptake in patients with coronary artery bypass grafts (CABG) is unknown. We aimed to characterize 18F-NaF activity in CABG patients. We performed 18F-NaF PET (30-min long single bed position acquisition 1h after a 250mB injection of 18F-NaF) and coronary CT angiography in patients with multivessel coronary artery disease and followed them for fatal or non-fatal myocardial infarction over 42 [31,49] months. On motion-corrected datasets we quantified the whole-vessel coronary 18F-NaF PET uptake (the coronary microcalcification activity (CMA)) by measuring the activity of voxels above the background (right atrium activity) + 2 * standard deviations threshold. All study subjects underwent a comprehensive baseline clinical assessment including evaluation of their cardiovascular risk factor profile with the SMART [Secondary Manifestations of Arterial Disease] risk score calculated, and the coronary calcium burden assessed with calcium scoring (CCS). Among 293 study participants (65±9 years; 84% male), 48 (16%) had a history of CABG. Although the majority 124/128 (97%) of coronary bypass grafts showed no uptake, 4 saphenous vein grafts presented with a CMA>0 (range: 2.5–11.5, Figure). While a similar proportion of patients with and without prior CABG showed increased coronary 18F-NaF uptake (CMA>0) (58.3% versus 71.4%, p=0.11) overall prior-CABG subjects had higher CMA (2.0 [0.3, 6.6] versus 0.6 [0, 2.7], p=0.001) and CCS (1135 [631, 2120] versus 225 [59, 542], p<0.001), respectively. In line with the differences in the calcification activity and the coronary calcium burden, the SMART risk scores were higher in CABG patients (23 [17, 28] versus 17 [12, 24], p=0.01), and these patients were also older (68±8 versus 64±8, p=0.01). Despite the aforementioned differences the incidence of myocardial infarction 5/48 (9%) versus 15/245 (6%) and MACE 6/48 (12%) versus 34/245 (14%) during follow-up between subjects with and without prior CABG was similar (p=0.44 and p=0.80, respectively). CABG patients have a higher coronary microcalcification activity on 18F-NaF PET than multivessel coronary artery disease patients without prior CABG. Despite evidence of higher 18F-NaF uptake there is no difference in outcome between these two groups. Figure 1. 18F-NaF uptake in CABG patients. (A) 63-year old male with prominent uptake in stented saphenous vein bypass grafts and native coronary arteries who experienced a non-fatal non ST elevation myocardial infarction during follow-up. (B) 70-year old male with evident uptake in native coronary arteries and only little 18F-NaF activity within coronary bypasses. Funding Acknowledgement Type of funding source: Other. Main funding source(s): National Heart, Lung, and Blood Institute/National Institute of Health (NHLBI/NIH), British Heart Foundation

scholarly journals Long‐Term (7‐Year) Clinical Implications of Newly Unveiled Asymptomatic Abnormal Ankle–Brachial Index in Patients With Coronary Artery Disease

2021 ◽  
Author(s):  
Jong‐Young Lee ◽  
Seung‐Jae Lee ◽  
Seung‐Whan Lee ◽  
Tae Oh Kim ◽  
Yujin Yang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Significant Coronary Artery Disease ◽  
Cox Proportional Hazards ◽  
Repeat Revascularization ◽  
Artery Disease

Background The long‐term impact of newly discovered, asymptomatic abnormal ankle–brachial index (ABI) in patients with significant coronary artery disease is limited. Methods and Results Between January 2006 and December 2009, ABI was evaluated in 2424 consecutive patients with no history of claudication or peripheral artery disease who had significant coronary artery disease. We previously reported a 3‐year result; therefore, the follow‐up period was extended. The primary end point was a composite of all‐cause death, myocardial infarction (MI), and stroke over 7 years. Of the 2424 patients with significant coronary artery disease, 385 had an abnormal ABI (ABI ≤0.9 or ≥1.4). During the follow‐up period, the rate of the primary outcome was significantly higher in the abnormal ABI group than in the normal ABI group ( P <0.001). The abnormal ABI group had a significantly higher risk of composite of all‐cause death/MI/stroke than the normal ABI group, after adjustment with multivariable Cox proportional hazards regression analysis (hazard ratio [HR], 2.07; 95% CI, 1.67–2.57; P <0.001) and propensity score–matched analysis (HR, 1.97; 95% CI, 1.49–2.60; P <0.001). In addition, an abnormal ABI was associated with a higher risk of all‐cause death, MI, and stroke, but not repeat revascularization. Conclusions Among patients with significant coronary artery disease, asymptomatic abnormal ABI was associated with sustained and increased incidence of composite of all‐cause death/MI/stroke, all‐cause death, MI, and stroke during extended follow‐up over 7 years.

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 808-815
Author(s):  
Andreas Tzoumas ◽  
Stefanos Giannopoulos ◽  
Nektarios Charisis ◽  
Pavlos Texakalidis ◽  
Damianos G Kokkinidis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Coronary Artery Bypass Graft ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Artery Disease

Background Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. Objective The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. Methods This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. Results Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00–13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88–23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18– 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02–3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04– 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03–4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02–3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50–27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01–12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84–15.20; I2 = 0.0%) after a mean follow-up of 47 months. Conclusion The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.

scholarly journals Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (7) ◽  
pp. 2231
Author(s):  
Gani Bajraktari ◽  
Fjolla Zhubi-Bakija ◽  
Gjin Ndrepepa ◽  
Fernando Alfonso ◽  
Shpend Elezi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Meta Analysis ◽  
Bypass Grafting ◽  
Left Main ◽  
Repeat Revascularization ◽  
Main Coronary Artery Disease ◽  
Artery Disease

Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was higher in patients assigned to PCI. Conclusions: The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization.

scholarly journals Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Coronary Artery Disease Patients with Advanced Chronic Kidney Disease: A Chinese Single-Center Study

2020 ◽  
Author(s):  
Yang Li ◽  
Hongliang Rui ◽  
Zhuhui Huang ◽  
Xiaoyu Xu ◽  
Taoshuai Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Advanced Chronic Kidney Disease ◽  
Repeat Revascularization ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Objectives Aims to compare the contemporary and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with advanced chronic kidney disease (CKD). Design Observational cohort study, single-center.Setting The largest cardiac surgery center in China.Participants 823 CAD patients with advanced CKD (eGFR<30 ml/min/1.73m2) were collected, including 247 patients who underwent CABG and 576 patients received PCI from January 2010 to February 2019. Main outcome measures The primary end point was all-cause death. The secondary end points included major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), stroke and revascularization.Results Multivariable Cox regression models were used for risk-adjustment and propensity score matching (PSM) was also performed. After PSM, the 30-day mortality rate in the CABG group was higher than that in the PCI group but without statistically significant (6.6%vs2.4%, p=0.0640). During the first year, patients referred for CABG had a hazard ratio (HR) of 1.42 [95% confidence interval (CI), 0.41–3.01] for mortality compared with PCI. At the end of the 5-year follow-up, CABG group had a HR of 0.58 (95%CI, 0.38-0.86) for repeat revascularization, a HR of 0.77 (95%CI, 0.52-1.14) for survival rate and a HR of 0.88(95%CI, 0.56-1.18) for MACCE as compared to PCI. Conclusions Our study suggests that among advanced CKD patients，CABG showed obviously lower risk for repeat revascularization and slightly better prognosis regarding to mortality and other adverse events compared with PCI during the long-term follow-up. At a mean pooled follow-up of one year, both mortality and MACCEs were comparable in both cohorts.

Sign in / Sign up

Export Citation Format

Share Document