Stenting and medical therapy for atherosclerotic renal-artery stenosis

Christopher J. Cooper, Timothy P. Murphy, Donald E. Cutlip, Kenneth Jamerson, William Henrich, Diane M. Reid, David J. Cohen, Alan H. Matsumoto, Michael W Steffes, Michael R. Jaff, Martin R. Prince, Eldrin F. Lewis, Katherine R. Tuttle, Joseph I. Shapiro, John H. Rundback, Joseph M. Massaro, Ralph B. D'Agostino, Lance D. Dworkin

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. METHODS: We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). RESULTS: Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the 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% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P = 0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P = 0.03). CONCLUSIONS: Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)13-22
Number of pages10
JournalNew England Journal of Medicine
Volume370
Issue number1
DOIs
StatePublished - Jan 1 2014

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Renal Artery Obstruction
Renal Artery
Kidney
Chronic Renal Insufficiency
Therapeutics
Confidence Intervals
Blood Pressure
Renal Hypertension
Renal Replacement Therapy
Antihypertensive Agents
Stents
Renal Insufficiency
Hospitalization
Heart Failure
Stroke
Myocardial Infarction
Hypertension
Mortality

Cite this

Cooper, C. J., Murphy, T. P., Cutlip, D. E., Jamerson, K., Henrich, W., Reid, D. M., ... Dworkin, L. D. (2014). Stenting and medical therapy for atherosclerotic renal-artery stenosis. New England Journal of Medicine, 370(1), 13-22. https://doi.org/10.1056/NEJMoa1310753

Stenting and medical therapy for atherosclerotic renal-artery stenosis. / Cooper, Christopher J.; Murphy, Timothy P.; Cutlip, Donald E.; Jamerson, Kenneth; Henrich, William; Reid, Diane M.; Cohen, David J.; Matsumoto, Alan H.; Steffes, Michael W; Jaff, Michael R.; Prince, Martin R.; Lewis, Eldrin F.; Tuttle, Katherine R.; Shapiro, Joseph I.; Rundback, John H.; Massaro, Joseph M.; D'Agostino, Ralph B.; Dworkin, Lance D.

In: New England Journal of Medicine, Vol. 370, No. 1, 01.01.2014, p. 13-22.

Research output: Contribution to journalArticle

Cooper, CJ, Murphy, TP, Cutlip, DE, Jamerson, K, Henrich, W, Reid, DM, Cohen, DJ, Matsumoto, AH, Steffes, MW, Jaff, MR, Prince, MR, Lewis, EF, Tuttle, KR, Shapiro, JI, Rundback, JH, Massaro, JM, D'Agostino, RB & Dworkin, LD 2014, 'Stenting and medical therapy for atherosclerotic renal-artery stenosis', New England Journal of Medicine, vol. 370, no. 1, pp. 13-22. https://doi.org/10.1056/NEJMoa1310753
Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. New England Journal of Medicine. 2014 Jan 1;370(1):13-22. https://doi.org/10.1056/NEJMoa1310753
Cooper, Christopher J. ; Murphy, Timothy P. ; Cutlip, Donald E. ; Jamerson, Kenneth ; Henrich, William ; Reid, Diane M. ; Cohen, David J. ; Matsumoto, Alan H. ; Steffes, Michael W ; Jaff, Michael R. ; Prince, Martin R. ; Lewis, Eldrin F. ; Tuttle, Katherine R. ; Shapiro, Joseph I. ; Rundback, John H. ; Massaro, Joseph M. ; D'Agostino, Ralph B. ; Dworkin, Lance D. / Stenting and medical therapy for atherosclerotic renal-artery stenosis. In: New England Journal of Medicine. 2014 ; Vol. 370, No. 1. pp. 13-22.
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AU - Murphy, Timothy P.

AU - Cutlip, Donald E.

AU - Jamerson, Kenneth

AU - Henrich, William

AU - Reid, Diane M.

AU - Cohen, David J.

AU - Matsumoto, Alan H.

AU - Steffes, Michael W

AU - Jaff, Michael R.

AU - Prince, Martin R.

AU - Lewis, Eldrin F.

AU - Tuttle, Katherine R.

AU - Shapiro, Joseph I.

AU - Rundback, John H.

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AU - D'Agostino, Ralph B.

AU - Dworkin, Lance D.

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N2 - BACKGROUND: Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. METHODS: We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). RESULTS: Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the 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% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P = 0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P = 0.03). CONCLUSIONS: Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease.

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