(P033) PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFTING FOR LEFT MAIN CORONARY ARTERY REVASCULARIZATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Friday, October 25, 2024

12:00 PM – 12:30 PM PT

Location: BOARD 35

Presenting Author(s)

HY

Hamza Yousaf, MD (he/him/his)

Resident Physician
University at Buffalo
Buffalo, New York, United States

Co-Author(s)

AS

Akash Sharma, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
SI

Sabeeh Islam, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
HK

Husam Katib, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
AA

Arshan Ali Khan, MD

Cardiology Fellow
Ascension St. John Hospital
Detroit, Michigan, United States
RS

Rija Shahid, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
JM

Jannat Malik, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
SS

Sumi Singh, MD

Resident Physician
University at Buffalo
Buffalo, New York, United States
MH

Muhammad Hanif, MD

Resident Physician
SUNY Upstate
Syracuse, New York, United States
HH

Haider Hasnain, MD

Resident Physician
Nishtar Medical University
Multan, Punjab, Pakistan

Disclosure(s):

Hamza Yousaf, MD: No financial relationships to disclose

Background: Left main coronary artery (LMCA) revascularization in patients with chronic kidney disease (CKD) with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear. We conducted a systematic review and meta-analysis to evaluate optimal revascularization therapy for left main coronary artery disease (LMCAD) in the CKD population.

METHODS AND RESULTS: Methods
We electronically searched studies focusing on the revascularization of LMCA by PCI or CABG in patients with CKD using PubMed and Embase databases. All studies comparing therapeutic effects and clinical adverse events of PCI versus CABG for revascularization of LMCA in patients with CKD published in the last 10 years were screened. Primary outcomes included major adverse cardiac and cerebrovascular events (MACCE). Secondary outcomes were all-cause mortality, cardiac mortality, cerebrovascular event (CVA), myocardial infarction (MI), repeat revascularization, and bleeding.

A total of 9 studies (6 retrospective, 2 randomized controlled trials (RCTs), and 1 prospective) with a total of 10,635 patients were screened and analyzed. Primary outcome: Our study did not show any significant difference in MACCE for patients treated with PCI as compared to the CABG group [odds ratio (OR) 1.05, confidence interval (CI) 0.68-1.61, p-value (P) 0.81]. Secondary outcomes: Patients undergoing PCI were found to have lower CVAs as compared to the CABG group [OR 0.49, CI 0.33-0.74, P < 0.01]. However, repeat revascularizations were lower in the CABG group as compared to PCI [OR 3.15, CI 1.03-9.69, P 0.05]. No significant difference was noted in all-cause mortality [OR 0.84, CI 0.48-1.46, P 0.48], MI [OR 1.47, CI 0.50-4.31, P 0.41], bleeding [OR 0.27, CI 0.05-1.35, P 0.07], cardiac mortality [OR 0.78, CI 0.22-2.80, P 0.59] between two groups.

Conclusion: PCI is comparable with CABG for revascularization of LMCA in patients with CKD. However, PCI was associated with a lower risk of CVA, and a higher risk of repeat revascularization as compared to the CABG group. Our findings further need to be validated by more prospective RCTs to identify optimal Revascularization strategy for LMCAD in the CKD population.