PMID- 31538964 OWN - NLM STAT- MEDLINE DCOM- 20200921 LR - 20200921 IS - 1897-9483 (Electronic) IS - 0032-3772 (Linking) VI - 129 IP - 11 DP - 2019 Nov 29 TI - Determinants of long-term outcome in patients after percutaneous stent-assisted intervention for renal artery steno-occlusive atherosclerotic disease. PG - 747-760 LID - 10.20452/pamw.14981 [doi] AB - INTRODUCTION: The effect of stent‑assisted percutaneous transluminal angioplasty (PTA) for renal artery stenosis (RAS) on systolic (SBP) and diastolic blood pressure (DBP) as well as renal function, in comparison with medical therapy, is still debatable. Data on determinants of cardiovascular (CV) outcome after PTA are lacking. OBJECTIVES: We aimed to identify determinants of major cardiac and cerebral events (MACCEs) following PTA for RAS. PATIENTS AND METHODS: A total of 248 PTAs for RAS were performed in 211 patients with difficult‑to‑treat hypertension and/or progressive renal impairment. The primary outcomes were procedural success, in‑hospital complications, renal function (estimated glomerular filtration rate [eGFR]), change in SBP or DBP, and an incidence of MACCEs during a median of 47 months (interquartile range [IQR], 18-78 months). RESULTS: Procedural success and complication rates were 99.2% and 4.7%, respectively. We observed significant differences in SBP, DBP, and eGFR at 12 months as compared with baseline. A total of 63 MACCEs (30.6%) were noted in 206 patients with available follow‑up data. The receiver operating characteristic curve analysis indicated the following best cutoff values for the risk of CV death: an increase in eGFR by at least 11 ml/min/1.73 m2 and a decrease in SBP and DBP by at least 20 mm Hg and 5 mm Hg, respectively. At 12‑month follow‑up, an increase in eGFR of at least 11 ml/min/1.73 m2 was independently associated with a reduced risk of death (hazard ratio [HR], 0.42; 95% CI, 0.19-0.90; P = 0.02) and MACCEs (HR, 0.54; 95% CI, 0.32-0.93; P = 0.03), while a decrease of DBP by 5 mm Hg or higher, with a reduced risk of stroke (HR, 0.1; 95% CI, 0.02-0.39; P = 0.001). CONCLUSIONS: This study confirms the efficacy and safety of PTA as well as its significant effect on changes in blood pressure and eGFR values. Patients with an increase in eGFR of at least 11 ml/min/1.73 m2 have a significant risk reduction of MACCEs and CV death, while those with a decrease in DBP of at least 5 mm Hg, of stroke. FAU - Roslawiecka, Agnieszka AU - Roslawiecka A AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Kablak-Ziembicka, Anna AU - Kablak-Ziembicka A AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Rzeznik, Daniel AU - Rzeznik D AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Pieniazek, Piotr AU - Pieniazek P AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland; Department of Vascular and Endovascular Surgery, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland; Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Badacz, Rafal AU - Badacz R AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Trystula, Mariusz AU - Trystula M AD - Department of Vascular and Endovascular Surgery, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland FAU - Przewlocki, Tadeusz AU - Przewlocki T AD - Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland; Department of Vascular and Endovascular Surgery, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland; Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland. tadeuszprzewlocki@op.pl LA - eng PT - Comparative Study PT - Journal Article DEP - 20190920 PL - Poland TA - Pol Arch Intern Med JT - Polish archives of internal medicine JID - 101700960 RN - 0 (Antihypertensive Agents) SB - IM CIN - Pol Arch Intern Med. 2019 Nov 29;129(11):735-737. doi: 10.20452/pamw.15075. PMID: 31782754 MH - Adult MH - Aged MH - Aged, 80 and over MH - Angioplasty/*methods MH - Antihypertensive Agents/*therapeutic use MH - Female MH - Follow-Up Studies MH - Humans MH - Hypertension/*drug therapy MH - Male MH - Middle Aged MH - Proportional Hazards Models MH - Renal Artery Obstruction/*drug therapy/*surgery MH - Retrospective Studies MH - Risk Assessment MH - *Stents MH - Treatment Outcome EDAT- 2019/09/21 06:00 MHDA- 2020/09/22 06:00 CRDT- 2019/09/21 06:00 PHST- 2019/09/21 06:00 [pubmed] PHST- 2020/09/22 06:00 [medline] PHST- 2019/09/21 06:00 [entrez] AID - 10.20452/pamw.14981 [doi] PST - ppublish SO - Pol Arch Intern Med. 2019 Nov 29;129(11):747-760. doi: 10.20452/pamw.14981. Epub 2019 Sep 20.