Meta-Analysis of Comparison of Drug-Eluting Stents and Bare-Metal Stents in Patients on Dialysis

Coronary artery disease is common in patients with end-stage renal disease who are on hemodialysis. The efficacy and safety of evidence regarding the use of drug-eluting stents (DES) and bare-metal stents (BMS) in patients with dialysis is unclear. We searched MEDLINE, EMBASE, Science Citation Index, CINAHL, and the Cochrane CENTRAL database of controlled clinical trials for controlled trials that compare DES and BMS in dialysis patients up to June 2016. We conducted a meta-analysis across 14 eligible studies (n = 62,250 patients). In general, DES-treated patients demonstrate a lower risk of the clinical adverse events compared with those treated with BMS. Significant reduction in the incidence of death (odds ratio [OR] 0.77, CI 0.64 to 0.92) and major adverse cardiovascular events (OR 0.65, CI 0.57 to 0.74) and target lesion/vessel revascularization (OR 0.83, CI 0.73 to 0.94), and a trend toward lower OR for myocardial infarction (OR 0.95, CI 0.87 to 1.02) were noted in DES-treated patients. In conclusion, the use of DES in patients with dialysis yields significant decrease in the risk of mortality, major adverse cardiovascular events, and target lesion/vessel revascularization. Larger randomized studies are needed to confirm the results of this meta-analysis and establish the appropriate stent choice in this high-risk population.