| What is already known |
Patients with CKD have an increased risk of post-PCI adverse events compared to the general population. DES is generally associated with improved outcomes compared to BMS in both the general population and CKD patients. DES implantation in the ESRD population on regular dialysis shows a reduced rate of revascularisation over longer follow-up (>1 year). |
| What this review adds |
No study focusing on DAPT duration post PCI in CKD/ESRD patients has yet been done. Results from available trials highlight that adverse events are higher in the CKD population. Among the CKD population, there is no observable benefit in extending DAPT duration beyond 12 months. In non-dialysis-dependent CKD patients, CABG improves mortality, repeat revascularisation and MI compared to PCI. There is no mortality difference when comparing first- and second-generation DES, while comparison of DES with BMS yields mixed results. In ESRD on regular haemodialysis, CABG provides long-term benefit despite short-term increased risk of adverse events. There is no significant mortality difference when first- and second-generation DES are compared, though there is a reduced repeat revascularisation rate with second-generation DES. Finally, DES provides mortality benefit over BMS. |
| Clinical implications & future directions |
CABG is still the intervention of choice for CKD/ESRD patients requiring coronary revascularisation, provided fitness for surgery. CKD/ESRD patients will greatly benefit from RCTs/prospective studies focusing on DAPT choice and duration, especially in the advent of novel P2Y12 inhibitors and second-generation DES. |
| BMS: bare metal stent; CABG: coronary artery bypass grafting; CKD: chronic kidney disease; DAPT: dual antiplatelet therapy; DES: drug-eluting stent; ESRD: end-stage renal disease; PCI: percutaneous coronary intervention; RCT: randomised controlled trial; ST: stent thrombosis |
