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Long-Term Outcomes of Drug-Eluting Stents versus Bare-Metal Stents in End Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis
Abstract.There are no dedicated data to guide drug eluting stent (DES) versus bare metal stent (BMS) selection in patients with end stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent-type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of non-randomized studies extracted from PubMed, Scopus, and EMBASE; assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method. Random-effects model was used for all analyses. A total of 17 non-randomized studies (N=63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis; median follow-up of 1 year (range: 9 months – 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95%CI 0.64-0.89, P<0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95%CI 0.60-0.99, P=0.047) and target lesion/vessel revascularization (TLR/TVR) (OR 0.78, 95%CI 0.64-0.94, P=0.01). However, there were no differences in non-cardiovascular mortality, myocardial infarction, stent thrombosis, stroke or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes following percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, TLR/TVR, and cardiovascular death.
Impact of Implantable Cardioverter-Defibrillator Interventions on All-Cause Mortality in Heart Failure Patients – A Meta-Analysis
Abstract. Implantable cardioverter-defibrillators (ICDs) have a unique role in the primary and secondary prevention of sudden cardiac death. However, appropriate and inappropriate ICD interventions [anti-tachycardia pacing (ATP) or shocks] can result in deleterious effects. The aim of our study was to systematically review the existing data about the impact of ICD interventions on all-cause mortality in heart failure patients with reduced ejection fraction (HFrEF). We systematically searched MEDLINE (by using PubMed Web-based search engine) without any limits until 30 September 2017. After screening 17752 records, a total of 17 studies met our inclusion criteria and were included in our meta-analysis. Our data showed that, in patients with HFrEF, appropriate [HR 2.00 (95% CI (1.52-2.63), p<0.01, I2 88%]] and inappropriate [HR 1.30 (95% CI (1.07-1.58), p<0.01, I2 26%] ICD interventions were significantly associated with increased all-cause mortality. However, neither appropriate ATP [HR 1.27 (95% CI (0.80-2.02), p=0.30, I2 62%] nor inappropriate ATP [HR 1.01 (95% CI (0.49-2.07), p=0.98, I2 46%]] were significantly associated with all-cause mortality in this patient population. In conclusion, ICD shocks are associated with a worse prognosis in HFrEF.