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Thirty-Day Readmission After Medical Versus Endovascular Therapy for Atherosclerotic Renal Artery Stenosis

Published:January 09, 2020DOI:https://doi.org/10.1016/j.amjcard.2019.12.042
      Whether renal artery stenting (RAS) confers benefit over medical therapy (MT) alone in patients with atherosclerotic renal artery stenosis admitted with acute coronary syndromes (ACS), congestive heart failure (CHF), or hypertensive crisis remains unknown. We identified a nationally-weighted cohort of 116,056 patients from the Nationwide Readmissions Database with a preexisting diagnosis of atherosclerotic renal artery stenosis and an index hospitalization diagnosis of ACS, CHF, or hypertensive crisis, and propensity-matched on the likelihood of undergoing inpatient RAS. Thirty-day readmission rates, index hospitalization complications, hospital lengths-of-stay, and cost were compared between treatment groups. Overall, all-cause, nonelective 30-day readmission rates did not differ between RAS and MT alone (18.2% vs 18.7%, respectively, p = 0.49). RAS was associated with higher index rates of acute kidney injury, major bleeding, transfusion, and vascular complications, and were similar irrespective of index hospitalization diagnosis. Index hospitalization length of stay (6 vs 4 days; p <0.001) and cost ($23,020 vs. $11,459; p <0.001) were higher with RAS. In conclusion, nearly 1-in-5 patients hospitalized with atherosclerotic renal artery stenosis and ACS, CHF, or hypertensive crisis were readmitted within 30-days. Index hospitalization complications occurred more frequently among those treated with RAS than MT alone, but the likelihood of readmission did not differ by treatment strategy.
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      References

        • Safian RD
        • Textor SC
        Renal-artery stenosis.
        N Engl J Med. 2001; 344: 431-442
        • Hansen KJ
        • Edwards MS
        • Craven TE
        • Cherr GS
        • Jackson SA
        • Appel RG
        • Burke GL
        • Dean RH
        Prevalence of renovascular disease in the elderly: a population-based study.
        J Vasc Surg. 2002; 36: 443-451
        • Liang P
        • Hurks R
        • Bensley RP
        • Hamdan A
        • Wyers M
        • Chaikof E
        • Schermerhorn ML
        The rise and fall of renal artery angioplasty and stenting in the United States, 1988-2009.
        J Vasc Surg. 2013; 58 (e1): 1331-1338
        • Bax L
        • Woittiez AJ
        • Kouwenberg HJ
        • Mali WP
        • Buskens E
        • Beek FJ
        • Braam B
        • Huysmans FT
        • Schultze Kool LJ
        • Rutten MJ
        • Doorenbos CJ
        • Aarts JC
        • Rabelink TJ
        • Plouin PF
        • Raynaud A
        • van Montfrans GA
        • Reekers JA
        • van den Meiracker AH
        • Pattynama PM
        • van de Ven PJ
        • Vroegindeweij D
        • Kroon AA
        • de Haan MW
        • Postma CT
        • Beutler JJ
        Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.
        Ann Intern Med. 2009; 150 (W150-151): 840-848
        • Cooper CJ
        • Murphy TP
        • Cutlip DE
        • Jamerson K
        • Henrich W
        • Reid DM
        • Cohen DJ
        • Matsumoto AH
        • Steffes M
        • Jaff MR
        • Prince MR
        • Lewis EF
        • Tuttle KR
        • Shapiro JI
        • Rundback JH
        • Massaro JM
        • D'Agostino Sr., RB
        • Dworkin LD
        • Investigators C
        Stenting and medical therapy for atherosclerotic renal-artery stenosis.
        N Engl J Med. 2014; 370: 13-22
        • Wheatley K
        • Ives N
        • Gray R
        • Kalra PA
        • Moss JG
        • Baigent C
        • Carr S
        • Chalmers N
        • Eadington D
        • Hamilton G
        • Lipkin G
        • Nicholson A
        • Scoble J
        Revascularization versus medical therapy for renal-artery stenosis.
        N Engl J Med. 2009; 361: 1953-1962
        • Plouin PF
        • Chatellier G
        • Darne B
        • Raynaud A
        Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group.
        Hypertension. 1998; 31: 823-829
        • Scarpioni R
        • Michieletti E
        • Cristinelli L
        • Ugolotti U
        • Scolari F
        • Venturelli C
        • Cancarini G
        • Pecchini P
        • Malberti F
        • Maroldi R
        • Rozzi G
        • Olivetti L
        Atherosclerotic renovascular disease: medical therapy versus medical therapy plus renal artery stenting in preventing renal failure progression: the rationale and study design of a prospective, multicenter and randomized trial (NITER).
        J Nephrol. 2005; 18: 423-428
        • van Jaarsveld BC
        • Krijnen P
        • Pieterman H
        • Derkx FH
        • Deinum J
        • Postma CT
        • Dees A
        • Woittiez AJ
        • Bartelink AK
        • Man in 't Veld AJ
        • Schalekamp MA
        The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.
        N Engl J Med. 2000; 342: 1007-1014
        • Webster J
        • Marshall F
        • Abdalla M
        • Dominiczak A
        • Edwards R
        • Isles CG
        • Loose H
        • Main J
        • Padfield P
        • Russell IT
        • Walker B
        • Watson M
        • Wilkinson R
        Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group.
        J Hum Hypertens. 1998; 12: 329-335
        • NRD Overview
        Healthcare Cost and Utilization Project (HCUP).
        Agency for Healthcare Research and Quality, Rockville, MD2017 (Accessed October 24, 2018)
        • Dua A
        • Desai S
        • Upchurch Jr., GR
        • Desai SS
        Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis.
        Vascular. 2016; 24: 9-18
        • Lima FV
        • Kolte D
        • Louis DW
        • Kennedy KF
        • Abbott JD
        • Soukas PA
        • Hyder ON
        • Mamdani ST
        • Aronow HD
        Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: insights from the Nationwide Readmissions Database.
        Vasc Med. 2019; 24: 216-223
        • Austin PC
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161
        • Austin PC
        • Grootendorst P
        • Anderson GM
        A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study.
        Stat Med. 2007; 26: 734-753
        • Bergethon KE
        • Ju C
        • DeVore AD
        • Hardy NC
        • Fonarow GC
        • Yancy CW
        • Heidenreich PA
        • Bhatt DL
        • Peterson ED
        • Hernandez AF
        Trends in 30-day readmission rates for patients hospitalized with heart failure: findings from the get with the guidelines-heart failure registry.
        Circ Heart Fail. 2016; 9e002594
        • Hansen LO
        • Young RS
        • Hinami K
        • Leung A
        • Williams MV
        Interventions to reduce 30-day rehospitalization: a systematic review.
        Ann Intern Med. 2011; 155: 520-528
        • Hannan EL
        • Zhong Y
        • Lahey SJ
        • Culliford AT
        • Gold JP
        • Smith CR
        • Higgins RS
        • Jordan D
        • Wechsler A
        30-day readmissions after coronary artery bypass graft surgery in New York State.
        JACC Cardiovasc Interv. 2011; 4: 569-576
        • Smith LN
        • Makam AN
        • Darden D
        • Mayo H
        • Das SR
        • Halm EA
        • Nguyen OK
        Acute myocardial infarction readmission risk prediction models: a systematic review of model performance.
        Circ Cardiovasc Qual Outcomes. 2018; 11e003885
        • Riaz IB
        • Husnain M
        • Riaz H
        • Asawaeer M
        • Bilal J
        • Pandit A
        • Shetty R
        • Lee KS
        Meta-analysis of revascularization versus medical therapy for atherosclerotic renal artery stenosis.
        Am J Cardiol. 2014; 114: 1116-1123
        • Chen W
        • Kayler LK
        • Zand MS
        • Muttana R
        • Chernyak V
        • DeBoccardo GO
        Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy.
        Clin Kidney J. 2015; 8: 71-78
        • Ma Z
        • Liu L
        • Zhang B
        • Chen W
        • Yang J
        • Li H
        Renal artery stent in solitary functioning kidneys: 77% of benefit: a systematic review with meta-analysis.
        Medicine (Baltimore). 2016; 95: e4780
        • Kalra PA
        • Chrysochou C
        • Green D
        • Cheung CM
        • Khavandi K
        • Sixt S
        • Rastan A
        • Zeller T
        The benefit of renal artery stenting in patients with atheromatous renovascular disease and advanced chronic kidney disease.
        Catheter Cardiovasc Interv. 2010; 75: 1-10
        • Murphy TP
        • Cooper CJ
        • Pencina KM
        • D'Agostino R
        • Massaro J
        • Cutlip DE
        • Jamerson K
        • Matsumoto AH
        • Henrich W
        • Shapiro JI
        • Tuttle KR
        • Cohen DJ
        • Steffes M
        • Gao Q
        • Metzger DC
        • Abernethy WB
        • Textor SC
        • Briguglio J
        • Hirsch AT
        • Tobe S
        • Dworkin LD
        Relationship of albuminuria and renal artery stent outcomes: results from the CORAL randomized clinical trial (Cardiovascular Outcomes With Renal Artery Lesions).
        Hypertension. 2016; 68: 1145-1152
        • Hirsch AT
        • Haskal ZJ
        • Hertzer NR
        • Bakal CW
        • Creager MA
        • Halperin JL
        • Hiratzka LF
        • Murphy WR
        • Olin JW
        • Puschett JB
        • Rosenfield KA
        • Sacks D
        • Stanley JC
        • Taylor Jr., LM
        • White CJ
        • White J
        • White RA
        • Antman EM
        • Smith Jr., SC
        • Adams CD
        • Anderson JL
        • Faxon DP
        • Fuster V
        • Gibbons RJ
        • Hunt SA
        • Jacobs AK
        • Nishimura R
        • Ornato JP
        • Page RL
        • Riegel B
        • American Association for Vascular S
        • Society for Vascular S
        • Society for Cardiovascular A
        • Interventions
        • Society for Vascular M
        • Biology
        • Society of Interventional R
        • Disease AATFoPGWCtDGftMoPWPA
        • American Association of C
        • Pulmonary R
        • National Heart L
        • Blood I
        • Society for Vascular N
        • TransAtlantic Inter-Society C
        • Vascular Disease F
        ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation.
        Circulation. 2006; 113: e463-e654
        • Klein AJ
        • Jaff MR
        • Gray BH
        • Aronow HD
        • Bersin RM
        • Diaz-Sandoval LJ
        • Dieter RS
        • Drachman DE
        • Feldman DN
        • Gigliotti OS
        • Gupta K
        • Parikh SA
        • Pinto DS
        • Shishehbor MH
        • White CJ
        SCAI appropriate use criteria for peripheral arterial interventions: an update.
        Catheter Cardiovasc Interv. 2017; 90: E90-E110
        • Atti V
        • Patel NJ
        • Kumar V
        • Tripathi B
        • Basir MB
        • Voeltz M
        • Baber U
        • Kini AS
        • Sharma SK
        • O'Neill WW
        • Bhatt DL
        Frequency of 30-day readmission and its causes after percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock.
        Catheter Cardiovasc Interv. 2019; 94: E67-E77