Peripheral Arterial Disease
Meta-Analysis of Revascularization Versus Medical Therapy for Atherosclerotic Renal Artery Stenosis

https://doi.org/10.1016/j.amjcard.2014.06.033Get rights and content

The aim of the study was to compare the efficacy of revascularization versus medical therapy in patients with atherosclerotic renal artery stenosis (ARAS). ARAS is the most common cause of secondary hypertension and is associated with several complications, such as renal failure, coronary artery disease, cardiac destabilization, and stroke. Medical therapy is the cornerstone for management of ARAS; however, numerous trials have compared medical therapy with revascularization in the form of percutaneous renal artery angioplasty (PTRA) or percutaneous renal artery angioplasty with stent placement (PTRAS). Medline (PubMed and Ovid SP), Embase, Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Cochrane Database of Systematic Review (CDSR) were searched till present (November 2013) to identify clinical trials where medical therapy was compared with revascularization (PTRA or PTRAS). We performed a meta-analysis using a random effects model. The heterogeneity was assessed using I2 values. The initial database search identified 540 studies and 7 randomized controlled trials, and 2,139 patients were included in the final analysis. Angioplasty with or without stenting was not superior to medical therapy with respect to any outcome. The incidence of nonfatal myocardial infarction was 6.74% in both the stenting and medical therapy group (odds ratio = 0.998, 95% confidence interval 0.698 to 1.427, p = 0.992), and incidence of renal events in stenting population was found to be 19.58% versus 20.53% in medical therapy (odds ratio = 0.945, 95% confidence interval 0.755 to 1.182, p = 0.620). In conclusion, PTRA or PTRAS does not improve outcomes compared with medical therapy in patients with ARAS. Future studies should investigate to identify patient subgroups that may benefit from such an intervention.

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Methods

Literature search was conducted using methods described in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.14 Medline (PubMed and Ovid SP), Embase, Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Cochrane Database of Systematic Review (CDSR) were searched from the inception of these databases till present (November 2013). We used “renal artery stenosis,” “randomized controlled trials,” “angioplasty,” “surgical intervention,” and

Results

We found 540 titles during the initial database search. After screening the titles, 95 studies were eligible for further review, and 7 randomized controlled trials1, 16, 17, 18, 19, 20, 21 were included in the meta-analysis. The search strategy is shown in the PRISMA sheet (Figure 1).

In the included trials, intensive medical therapy was compared against angioplasty with1, 16, 21 or without stenting19, 20 in the patients with ARAS. The primary outcome measure was systolic blood pressure

Discussion

In the present meta-analysis, we report aggregate data from 7 randomized controlled trials on the efficacy of renal vascular interventions (angioplasty or stenting) compared with medical therapy in ARAS. Our results failed to demonstrate superiority of angioplasty or stenting versus medical therapy across a wide range of clinical end points including systolic blood pressure, death, nonfatal MI, hospitalization because of CHF, stroke, and worsening of renal function with the resultant need for

Disclosures

The authors have no conflicts of interest to disclose.

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