OBJECTIVES: To compare outcomes of two different revascularization strategies in chronic kidney disease (CKD) patients: coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). METHODS: We conducted this meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analyses 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 major adverse cardiovascular and cerebrovascular event rates, with secondary end-points including 30-day mortality, stroke, myocardial infarction (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/1.73 m2). The cohort comprised 132 314 coronary artery bypass graft and 269 986 PCI patients. Over 3 years, coronary artery bypass group provided protection against major adverse cardiac and cerebrovascular events, MI, and repeat revascularization compared to PCI. However, PCI 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 CKD and coronary artery disease patients should balance PCI's short-term benefits with CABG's long-term advantages.