Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials
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 re...
Gespeichert in:
| Veröffentlicht in: | The American heart journal 2011-03, Vol.161 (3), p.622-630.e1 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 630.e1 |
|---|---|
| container_issue | 3 |
| container_start_page | 622 |
| container_title | The American heart journal |
| container_volume | 161 |
| creator | Kumbhani, Dharam J., MD, SM Bavry, Anthony A., MD, MPH Harvey, James E., MD, MSc de Souza, Russell, RD, MSc Scarpioni, Roberto, MD Bhatt, Deepak L., MD, MPH Kapadia, Samir R., MD |
| description | 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. |
| doi_str_mv | 10.1016/j.ahj.2010.12.006 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_856788272</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870310011646</els_id><sourcerecordid>3382435551</sourcerecordid><originalsourceid>FETCH-LOGICAL-c465t-c0454ed3e04d8744b1fadf8fc24c7262b8fe246c3cb601b8863b5bc8f287ea223</originalsourceid><addsrcrecordid>eNp9ks2O0zAUhSMEYsrAA7BBlhBilWI7ruOChDSq-JNGYgGsLce5nnFJ7GI7RZ3n4gG5oYWRZsHKdvyd69xzblU9ZXTJKJOvtktzvV1yOp_5klJ5r1owum5r2Qpxv1pQSnmtWtqcVY9y3uJRciUfVmecNWsuOV1UvzaDD96agcSp2DhCJsYVSGQHyU7FBIhTJgn2JttpMMnfmOJjIHtIGS9G6P-IRxPMFYwQCvGB7JDBbSY_fbkm2V8F7xDDywQBaZPwhQPJBULMPr8mF1iomBqLDAf8QKIjyYQ-jv4GemJjKCkOA25L8mbIj6sHDhd4clrPq2_v333dfKwvP3_4tLm4rK2Qq1JbKlYC-gao6BU60jFneqec5cK22H6nHHAhbWM7SVmnlGy6VWeV46oFw3lzXr081t2l-GOCXPTos4VhONqi1Uq2SvF2Jp_fIbdxSthO1mwlEGoomyl2pGyKOSdwepf8aNJBM6rnRPVWY6J6TlQzrjEv1Dw7VZ46dPuf4m-ECLw4ARiRGRwaZ32-5Zp1q1grkHtz5AAd23tIOltMyWKCCWzRffT__Y23d9T2NDjf4QD5tludUaC_zKM3Tx6jlDEpZPMbi1nX9A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1547883012</pqid></control><display><type>article</type><title>Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Kumbhani, Dharam J., MD, SM ; Bavry, Anthony A., MD, MPH ; Harvey, James E., MD, MSc ; de Souza, Russell, RD, MSc ; Scarpioni, Roberto, MD ; Bhatt, Deepak L., MD, MPH ; Kapadia, Samir R., MD</creator><creatorcontrib>Kumbhani, Dharam J., MD, SM ; Bavry, Anthony A., MD, MPH ; Harvey, James E., MD, MSc ; de Souza, Russell, RD, MSc ; Scarpioni, Roberto, MD ; Bhatt, Deepak L., MD, MPH ; Kapadia, Samir R., MD</creatorcontrib><description>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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2010.12.006</identifier><identifier>PMID: 21392620</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Angioplasty, Balloon ; Antihypertensive Agents - therapeutic use ; Atherosclerosis ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Clinical outcomes ; Clinical trials ; Creatinine - blood ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Drug therapy ; Humans ; Hypertension ; Kidneys ; Medical sciences ; Mortality ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Randomized Controlled Trials as Topic ; Renal Artery Obstruction - physiopathology ; Renal Artery Obstruction - surgery ; Renal Artery Obstruction - therapy ; Renovascular diseases ; Sensitivity analysis ; Stents ; Stroke ; Studies ; Treatment Outcome ; Urinary system involvement in other diseases. Miscellaneous</subject><ispartof>The American heart journal, 2011-03, Vol.161 (3), p.622-630.e1</ispartof><rights>Mosby, Inc.</rights><rights>2011 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-c0454ed3e04d8744b1fadf8fc24c7262b8fe246c3cb601b8863b5bc8f287ea223</citedby><cites>FETCH-LOGICAL-c465t-c0454ed3e04d8744b1fadf8fc24c7262b8fe246c3cb601b8863b5bc8f287ea223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1547883012?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23978174$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21392620$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumbhani, Dharam J., MD, SM</creatorcontrib><creatorcontrib>Bavry, Anthony A., MD, MPH</creatorcontrib><creatorcontrib>Harvey, James E., MD, MSc</creatorcontrib><creatorcontrib>de Souza, Russell, RD, MSc</creatorcontrib><creatorcontrib>Scarpioni, Roberto, MD</creatorcontrib><creatorcontrib>Bhatt, Deepak L., MD, MPH</creatorcontrib><creatorcontrib>Kapadia, Samir R., MD</creatorcontrib><title>Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>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.</description><subject>Angioplasty, Balloon</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Atherosclerosis</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Creatinine - blood</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Drug therapy</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidneys</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Renal Artery Obstruction - physiopathology</subject><subject>Renal Artery Obstruction - surgery</subject><subject>Renal Artery Obstruction - therapy</subject><subject>Renovascular diseases</subject><subject>Sensitivity analysis</subject><subject>Stents</subject><subject>Stroke</subject><subject>Studies</subject><subject>Treatment Outcome</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ks2O0zAUhSMEYsrAA7BBlhBilWI7ruOChDSq-JNGYgGsLce5nnFJ7GI7RZ3n4gG5oYWRZsHKdvyd69xzblU9ZXTJKJOvtktzvV1yOp_5klJ5r1owum5r2Qpxv1pQSnmtWtqcVY9y3uJRciUfVmecNWsuOV1UvzaDD96agcSp2DhCJsYVSGQHyU7FBIhTJgn2JttpMMnfmOJjIHtIGS9G6P-IRxPMFYwQCvGB7JDBbSY_fbkm2V8F7xDDywQBaZPwhQPJBULMPr8mF1iomBqLDAf8QKIjyYQ-jv4GemJjKCkOA25L8mbIj6sHDhd4clrPq2_v333dfKwvP3_4tLm4rK2Qq1JbKlYC-gao6BU60jFneqec5cK22H6nHHAhbWM7SVmnlGy6VWeV46oFw3lzXr081t2l-GOCXPTos4VhONqi1Uq2SvF2Jp_fIbdxSthO1mwlEGoomyl2pGyKOSdwepf8aNJBM6rnRPVWY6J6TlQzrjEv1Dw7VZ46dPuf4m-ECLw4ARiRGRwaZ32-5Zp1q1grkHtz5AAd23tIOltMyWKCCWzRffT__Y23d9T2NDjf4QD5tludUaC_zKM3Tx6jlDEpZPMbi1nX9A</recordid><startdate>20110301</startdate><enddate>20110301</enddate><creator>Kumbhani, Dharam J., MD, SM</creator><creator>Bavry, Anthony A., MD, MPH</creator><creator>Harvey, James E., MD, MSc</creator><creator>de Souza, Russell, RD, MSc</creator><creator>Scarpioni, Roberto, MD</creator><creator>Bhatt, Deepak L., MD, MPH</creator><creator>Kapadia, Samir R., MD</creator><general>Elsevier Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20110301</creationdate><title>Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials</title><author>Kumbhani, Dharam J., MD, SM ; Bavry, Anthony A., MD, MPH ; Harvey, James E., MD, MSc ; de Souza, Russell, RD, MSc ; Scarpioni, Roberto, MD ; Bhatt, Deepak L., MD, MPH ; Kapadia, Samir R., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c465t-c0454ed3e04d8744b1fadf8fc24c7262b8fe246c3cb601b8863b5bc8f287ea223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Angioplasty, Balloon</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Atherosclerosis</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Creatinine - blood</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Drug therapy</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Kidneys</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Renal Artery Obstruction - physiopathology</topic><topic>Renal Artery Obstruction - surgery</topic><topic>Renal Artery Obstruction - therapy</topic><topic>Renovascular diseases</topic><topic>Sensitivity analysis</topic><topic>Stents</topic><topic>Stroke</topic><topic>Studies</topic><topic>Treatment Outcome</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumbhani, Dharam J., MD, SM</creatorcontrib><creatorcontrib>Bavry, Anthony A., MD, MPH</creatorcontrib><creatorcontrib>Harvey, James E., MD, MSc</creatorcontrib><creatorcontrib>de Souza, Russell, RD, MSc</creatorcontrib><creatorcontrib>Scarpioni, Roberto, MD</creatorcontrib><creatorcontrib>Bhatt, Deepak L., MD, MPH</creatorcontrib><creatorcontrib>Kapadia, Samir R., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumbhani, Dharam J., MD, SM</au><au>Bavry, Anthony A., MD, MPH</au><au>Harvey, James E., MD, MSc</au><au>de Souza, Russell, RD, MSc</au><au>Scarpioni, Roberto, MD</au><au>Bhatt, Deepak L., MD, MPH</au><au>Kapadia, Samir R., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2011-03-01</date><risdate>2011</risdate><volume>161</volume><issue>3</issue><spage>622</spage><epage>630.e1</epage><pages>622-630.e1</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21392620</pmid><doi>10.1016/j.ahj.2010.12.006</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-8703 |
| ispartof | The American heart journal, 2011-03, Vol.161 (3), p.622-630.e1 |
| issn | 0002-8703 1097-6744 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_856788272 |
| source | MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Angioplasty, Balloon Antihypertensive Agents - therapeutic use Atherosclerosis Biological and medical sciences Blood and lymphatic vessels Blood Pressure Cardiology. Vascular system Cardiovascular Cardiovascular disease Clinical outcomes Clinical trials Creatinine - blood Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Drug therapy Humans Hypertension Kidneys Medical sciences Mortality Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Randomized Controlled Trials as Topic Renal Artery Obstruction - physiopathology Renal Artery Obstruction - surgery Renal Artery Obstruction - therapy Renovascular diseases Sensitivity analysis Stents Stroke Studies Treatment Outcome Urinary system involvement in other diseases. Miscellaneous |
| title | Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-11T21%3A02%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20outcomes%20after%20percutaneous%20revascularization%20versus%20medical%20management%20in%20patients%20with%20significant%20renal%20artery%20stenosis:%20A%20meta-analysis%20of%20randomized%20controlled%20trials&rft.jtitle=The%20American%20heart%20journal&rft.au=Kumbhani,%20Dharam%20J.,%20MD,%20SM&rft.date=2011-03-01&rft.volume=161&rft.issue=3&rft.spage=622&rft.epage=630.e1&rft.pages=622-630.e1&rft.issn=0002-8703&rft.eissn=1097-6744&rft.coden=AHJOA2&rft_id=info:doi/10.1016/j.ahj.2010.12.006&rft_dat=%3Cproquest_cross%3E3382435551%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1547883012&rft_id=info:pmid/21392620&rft_els_id=S0002870310011646&rfr_iscdi=true |