Revascularization of atherosclerotic renal artery stenosis for chronic heart failure versus acute pulmonary oedema

AimThe aim of the study is to determine whether the apparent benefit of revascularization of renal artery stenosis for flash' pulmonary oedema extends to heart failure patients without a history of prior acute pulmonary oedema. MethodsA prospective study of patients with renal artery stenosis and heart failure at a single centre between 1 January 1995 and 31 December 2010. Patients were divided into those with and without previous acute pulmonary oedema/decompensation. Survival analysis compared revascularization versus medical therapy in each group using Cox regression adjusted for age, estimated glomerular filtration rate, blood pressure and co-morbidities. ResultsThere were 152 patients: 59% male, 36% diabetic, age 70 9 years, estimated glomerular filtration rate 29 17 mL/min per 1.73 m(2); 52 had experienced previous acute pulmonary oedema (34%), whereas 100 had no previous acute pulmonary oedema (66%). The revascularization rate was 31% in both groups. For heart failure without previous acute pulmonary oedema, the hazard ratio for death after revascularization compared with medical therapy was 0.76 (0.58-0.99, P = 0.04). In heart failure with previous acute pulmonary enema, the hazard ratio was 0.73 (0.44-1.21, P = 0.22). For those without previous acute pulmonary oedema, the hazard ratio for heart failure hospitalization after revascularization compared with medical therapy was 1.00 (0.17-6.05, P = 1.00). In those with previous acute pulmonary oedema, it was 0.51 (0.08-3.30, P = 0.48). ConclusionThe benefit of revascularization in heart failure may extend beyond the current indication of acute pulmonary oedema. However, findings derive from an observational study. Summary at a Glance An observational study showing the potential value of revascularization of renal artery stenosis in patients with heart failure even those with flash pulmonary edema.