OBJECTIVES: To compare outcomes of two different revascularization strategies in chronic kidney disease patients: coronary artery bypass grafting versus percutaneous coronary intervention. METHODS: we conducted this metanalysis according to PRISMA guidelines and registered with PROSPERO (CRD42021238659), evaluated studies comparing CABG and PCI in patients with CAD and CKD (defined by KDIGO guidelines). Data were extracted from PubMed, EMBASE, and Cochrane from 2000 to 2023. The primary end-point was long-term MACCE rates, with secondary end-points including 30-day mortality, stroke, MI, and repeat revascularization. Statistical analyses included Kaplan-Meier estimations, Cox regression, and meta-regression to address heterogeneity. Publication bias was assessed via funnel plots. No funding was received, and the authors report no conflicts of interest. RESULTS: We included 33 studies with 402,300 patients (eGFR <
60 mL/min/1.73m2). The cohort comprised 132,314 coronary artery bypass graft and 269,986 percutaneous coronary intervention patients.Over three years, coronary artery bypass group provided protection against major adverse cardiac and cerebrovascular events, myocardial infarction, and repeat revascularization compared to percutaneous coronary intervention. However, percutaneous coronary intervention showed better short-term outcomes, including lower 30-day mortality. Coronary artery bypass group was linked to a higher stroke risk over the 3-year follow-up. CONCLUSIONS: Revascularization strategies for chronic kidney disease and coronary artery disease patients should balance percutaneous coronary intervention's short-term benefits with coronary artery bypass grafting's long-term advantages.