Today at the American Heart Association (AHA) Scientific Sessions in Dallas new data were presented that compared renal artery stenting and multifactorial medical therapy to multifactorial medical therapy alone in patients with renal artery stenoses > 60% and uncontrolled hypertension on two or more medications. Results from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, also published today in the New England Journal of Medicine (NEJM), are consistent with the current guidelines and confirmed what most interventional cardiologists who practice renal stenting know to be true: effective medical therapy should be the first line of treatment in patients with presumed renovascular hypertension. For patients who fail medical therapy or are unable totolerate medical therapy, stenting remains a reasonable option.
The study evaluated 5,322 patients from 2005-2010, of which 947 were randomly assigned to stenting plus medical therapy (467 patients) or medical therapy alone (480 patients). Primary endpoints were death from cardiovascular or renal causes, stroke, myocardial infarction, hospitalization for congestive heart failure, progressive renal insufficiency or permanent renal-replacement therapy. Angiographic findings included 72.5 percent stenosis in the stenting plus medical therapy group vs. 74.3 percent in the medical therapy group.
Of note, results from CORAL also showed the benefit of medical therapy alone lessened over time. At 3-5 years post-enrollment, event-free survival declined in this patient group. This finding is worthy of continued study, as is the treatment of patients with hemodynamically severelesions and those who fail medical therapy. Similar to other patient populations, in the real-world setting, optimal medical therapy may present challenges with respect to compliance and tolerance of medications. Continued study of renal stenting is needed to ensure patients have options when medical therapy alone is not enough.
SCAI past-president Christopher White, MD, FSCAI, reviewed the CORAL findings and offered this video interview on the results from AHA. The study abstract may be found here.