Comprehensive drug and medical therapies appear better
A NATIONAL study from the Rhode Island Hospital, which was presented at the American Heart Association, found that renal stenting for renal artery stenosis do not benefit the patients unlike a comprehensive regimen of drug and medical therapies.
“The use of stenting to treat patients with renal artery stenosis is a treatment that clinicians have disagreed on for some time. Our findings clearly show that renal artery stenting does not confer any benefit for the prevention if clinical events when added to a comprehensive, multi-factorial medical therapy,” said Lance Dworking, MD, director of the Division of Hypertension & Kidney Disease at the hospital and co-researcher with Timothy Murphy, MD.
Published in the New England Journal of Medicine (NEJM) and entitled “Cardiovascular Outcomes in Renal Atherosclerotic Lesions” (CORAL), the study was done in collaboration with multiple investigators worldwide. The results were also presented at the annual meeting of the American Heart Association.
CORAL conducted a randomized controlled study with 947 participants located in 100 suites in the US, Canada, South America, Europe, Australia, and New Zealand.
All participants had atherosclerotic renal artery stenosis and either systolic hypertension on two or more drugs or chronic kidney disease, and were randomly given medical therapy with renal artery stenting or medical therapy alone.
The researchers monitored the participants for up to seven years for major clinical events like cardiovascular or renal death, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency or renal replacement therapy.
“Renal artery stenosis is a significant public health issue, so it was important that we go beyond following blood pressure and kidney function. To really understand what benefits, if any, stenting provided, we needed to look at significant clinical events,” said co-researcher Murphy, interventional radiologist and medical director of the Vascular Disease Research Center of the Hospital.
Over the median follow-up period of 43 months, the range of primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1 percent and 35.8 percent respectively; hazard ratio with stenting, 0.94; 95 percent confidence interval, 0.76 to 1.17; P=0.58).
No difference was found between the two treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. There was modest difference in systolic blood pressure in favor of the stent group during the follow-up (-2.3 mm Hg; 95 percent confidence interval, -4.4 to -0.2; P=0.03).
“Stents do a good job opening the arteries, but less invasive medical therapies, which have only gotten better over time means that patients can often avoid more invasive stenting procedures,” said Dworkin. Michaela Sarah De Leon with a NEJM report
VitalSigns Issue 58 Vol. 2, December 1-31, 2013