ABSTRACT
BACKGROUND: Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate. METHODS: We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses. RESULTS: This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38; p = 0.26). CONCLUSIONS: Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.
Subject(s)
Coronary Artery Bypass, Off-Pump/methods , Coronary Artery Bypass/methods , Renal Insufficiency, Chronic/complications , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass, Off-Pump/adverse effects , Humans , Postoperative Complications/epidemiology , Postoperative Complications/mortality , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/physiopathology , Treatment OutcomeABSTRACT
INTRODUCTION: The effects of preoperative statin therapy (PST) on renal outcomes in patients with isolated coronary artery bypass grafting (CABG) are in controversial. This study aimed to assess the effects of preoperative statin use on postoperative renal outcomes in patients undergoing isolated CABG. EVIDENCE ACQUISITION: PubMed, EMBASE, and Cochrane Library were searched for studies published up to February 2017. Pooled odds ratio (OR) and its corresponding 95% confidence interval (95% CI) were calculated. Outcomes evaluated were occurrence of postoperative acute kidney injury (AKI)/failure, requirement of any postoperative renal replacement therapy (RRT) and change in serum creatinine (Scr) levels. We used random-effects model and calculated pooled effect estimate of outcome between statin and non-statin use groups. EVIDENCE SYNTHESIS: Eighteen studies consisting of 32,747 patients following CABG were included. PST was associated with a significant protective effect for perioperative renal dysfunction (OR 0.89; 95% CI: 0.82-0.97; P=0.01) and postoperative requirement for RRT (OR 0.54; 95% CI: 0.41-0.72; P=0.001) in patients undergoing CABG surgery. However, there were no effects of preoperative statin therapy on the risk of postoperative AKI and serum creatinine concentration. In the subgroup of patients after on-pump CABG surgery, PST significantly reduced the perioperative renal dysfunction and requirement for RRT (OR 0.69; 95% CI: 0.53-0.89; P=0.005, OR 0.51; 95% CI: 0.30-0.87; P=0.014, respectively). CONCLUSIONS: In patients undergoing isolated CABG, PST might be associated with lower risk of postoperative renal dysfunction and the requirement for RRT. However, PST may not reduce the risk of AKI. Future large well-designed randomized controlled trials are needed on this topic.
Subject(s)
Acute Kidney Injury/etiology , Coronary Artery Bypass , Coronary Artery Disease/surgery , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Kidney/drug effects , Acute Kidney Injury/diagnosis , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , Aged , Biomarkers/blood , Chi-Square Distribution , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Creatinine/blood , Female , Humans , Kidney/physiopathology , Male , Middle Aged , Odds Ratio , Protective Factors , Renal Replacement Therapy , Risk Factors , Treatment OutcomeABSTRACT
A meta-analysis to determine the impact of gender on mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS): PubMed, EMBASE, and Cochrane Library, was systematically searched. Two investigators independently reviewed retrieved articles and assessed eligibility. Unadjusted mortality rates or adjusted effect estimates regarding gender-specific short-term and long-term all-cause mortality were identified. A total of 30 studies involving 358,827 patients with NSTE-ACS (129, 632 women and 229,195 men) were identified. In the unadjusted analysis, women had significantly higher risk of short-term all-cause mortality (RR 1.37; 95% CI 1.26-1.49; P < 0.00001) and long-term all-cause mortality (RR 1.18; 95% CI 1.07-1.31; P = 0.001) compared with men. However, when a meta-analysis was performed using adjusted effect estimates, the association between women and higher risk of short-term mortality (RR 0.99; 95% CI 0.91-1.07; P = 0.74) and long-term all-cause mortality (RR 0.84; 95% CI 0.68-1.03; P = 0.09) was markedly attenuated. Adjusted short-term and long-term all-cause mortality appeared similar in women and men. In conclusion, women with NSTE-ACS have higher short-term and long-term mortality compared with men. However, gender differences do not differ following adjustment for baseline cardiovascular risk factors and clinical differences.
