Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis

A meta-analysis of randomized controlled trials

Dharam J. Kumbhani, Anthony A. Bavry, James E. Harvey, Russell De Souza, Roberto Scarpioni, Deepak L. Bhatt, Samir R. Kapadia

Research output: Contribution to journalArticle

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Abstract

Background: We sought to systematically evaluate whether percutaneous revascularization is associated with additional clinical benefit in patients with renal artery stenosis (RAS) as compared with medical management alone. Methods: We included randomized controlled trials that compared percutaneous revascularization in addition to medical therapy versus medical management alone in patients with RAS. Six trials with 1,208 patients were included. Results: At a mean follow-up of 29 months, there was no change in systolic blood pressure (weighted mean difference [WMD] = 1.20 mm Hg, 95% CI -1.18 to 3.58 mm Hg) or diastolic blood pressure (WMD = -1.60 mm Hg, 95% CI -4.22 to 1.02 mm Hg) from baseline in the percutaneous revascularization arm compared with the medical management arm. There was a reduction in the mean number of antihypertensive medications (WMD = -0.26, 95% CI -0.39 to -0.13, P < .001), but not serum creatinine (WMD = -0.14 mg/dL, 95% CI -0.29 to 0.007 mg/dL), in the percutaneous revascularization arm at the end of follow-up. Percutaneous revascularization was not associated with a significant difference in all-cause mortality (relative risk [RR] = 0.96, 95% CI 0.74-1.25), congestive heart failure (RR = 0.79, 95% CI 0.56-1.13), stroke (RR = 0.86, 95% CI 0.50-1.47), or worsening renal function (RR = 0.91, 95% CI 0.67-1.23) as compared with medical management. Conclusions: In patients with RAS, percutaneous renal revascularization in addition to medical therapy may result in a lower requirement for antihypertensive medications, but not with improvements in serum creatinine or clinical outcomes, as compared with medical management over an intermediate period of follow-up. Further studies are needed to identify the appropriate patient population most likely to benefit from its use.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume161
Issue number3
DOIs
StatePublished - Mar 3 2011

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Renal Artery Obstruction
Meta-Analysis
Randomized Controlled Trials
Blood Pressure
Antihypertensive Agents
Creatinine
Kidney
Serum
Heart Failure
Stroke
Mortality
Therapeutics
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis : A meta-analysis of randomized controlled trials. / Kumbhani, Dharam J.; Bavry, Anthony A.; Harvey, James E.; De Souza, Russell; Scarpioni, Roberto; Bhatt, Deepak L.; Kapadia, Samir R.

In: American Heart Journal, Vol. 161, No. 3, 03.03.2011.

Research output: Contribution to journalArticle

Kumbhani, Dharam J. ; Bavry, Anthony A. ; Harvey, James E. ; De Souza, Russell ; Scarpioni, Roberto ; Bhatt, Deepak L. ; Kapadia, Samir R. / Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis : A meta-analysis of randomized controlled trials. In: American Heart Journal. 2011 ; Vol. 161, No. 3.
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abstract = "Background: We sought to systematically evaluate whether percutaneous revascularization is associated with additional clinical benefit in patients with renal artery stenosis (RAS) as compared with medical management alone. Methods: We included randomized controlled trials that compared percutaneous revascularization in addition to medical therapy versus medical management alone in patients with RAS. Six trials with 1,208 patients were included. Results: At a mean follow-up of 29 months, there was no change in systolic blood pressure (weighted mean difference [WMD] = 1.20 mm Hg, 95{\%} CI -1.18 to 3.58 mm Hg) or diastolic blood pressure (WMD = -1.60 mm Hg, 95{\%} CI -4.22 to 1.02 mm Hg) from baseline in the percutaneous revascularization arm compared with the medical management arm. There was a reduction in the mean number of antihypertensive medications (WMD = -0.26, 95{\%} CI -0.39 to -0.13, P < .001), but not serum creatinine (WMD = -0.14 mg/dL, 95{\%} CI -0.29 to 0.007 mg/dL), in the percutaneous revascularization arm at the end of follow-up. Percutaneous revascularization was not associated with a significant difference in all-cause mortality (relative risk [RR] = 0.96, 95{\%} CI 0.74-1.25), congestive heart failure (RR = 0.79, 95{\%} CI 0.56-1.13), stroke (RR = 0.86, 95{\%} CI 0.50-1.47), or worsening renal function (RR = 0.91, 95{\%} CI 0.67-1.23) as compared with medical management. Conclusions: In patients with RAS, percutaneous renal revascularization in addition to medical therapy may result in a lower requirement for antihypertensive medications, but not with improvements in serum creatinine or clinical outcomes, as compared with medical management over an intermediate period of follow-up. Further studies are needed to identify the appropriate patient population most likely to benefit from its use.",
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AU - Harvey, James E.

AU - De Souza, Russell

AU - Scarpioni, Roberto

AU - Bhatt, Deepak L.

AU - Kapadia, Samir R.

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