Meta-analysis: Renal artery stenting bests medical therapy alone

LAS VEGAS — In a new meta-analysis, renal artery stenting significantly reduced the risk for serious adverse events, compared with medical therapy alone, in patients with renal artery stenosis.

The meta-analysis included six randomized controlled trials covering 2,031 patients with renal artery stenosis. The researchers’ goal was to evaluate renal artery stenting vs. medical therapy alone. Evaluated factors included the incidence of death, stroke, HF and worsening renal function, both alone and as a composite endpoint.

All patients received medical therapy, and 1,006 patients also underwent renal artery stenting. Of the included trials, three provided data on the composite endpoint in a total of 1,877 patients. Those who underwent renal artery stenting in addition to receiving medical therapy had a 10% lower risk for the composite endpoint of death, stroke, HF and worsening renal function compared with those who received medical therapy alone (P=.004).

Across five trials with data on requirements for antihypertensive medications, the need for antihypertensive medication was significantly lower among renal artery stent recipients (WMD= –0.34; 95% CI, –0.61 to –0.07). Changes in systolic and diastolic BP did not differ significantly between the groups.

These findings differ from results from the CORAL trial, which indicated that renal artery stenting conferred no benefit with regard to a reduction in clinical events compared with multifactorial medical therapy, as previously reported by Cardiology Today.

Alexandre M. Benjo

According to Alexandre M. Benjo, MD, PhD, and colleagues, the larger sample size of the meta-analysis may explain the difference in results from randomized controlled trials.

Benjo told Cardiology Today that the studies typically did not include patients who had indications for revascularization according to the current guidelines. In one trial, half of the participants did not have significant stenosis; in another study, there was a lower average number of antihypertensive medications used per patient than indicated by the current guidelines as eligible for revascularization. Benjo also said the significant benefits of renal artery stenting observed in this meta-analysis persisted despite the aforementioned observations, and the benefits may have appeared more pronounced within a population selected according to the current indications for revascularization.

“Renal artery stenting is still a great therapy,” Benjo said. “None of these trials really selected patients [according to] the current indication and, even so, you still have benefits. Renal artery stenting for borderline indications still may have a role, especially if we can better stratify the patients.” – by Adam Taliercio

For more information:

Benjo A. B-034. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.

Disclosure: Benjo reports no relevant financial disclosures.