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Original research article
Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis
  1. Timion A Meijs1,
  2. Evangeline G Warmerdam1,
  3. Martijn G Slieker2,
  4. Gregor J Krings2,
  5. Mirella M C Molenschot2,
  6. Folkert J Meijboom1,
  7. Gertjan T Sieswerda1,
  8. Pieter A Doevendans1,3,
  9. Berto J Bouma4,
  10. Robbert J de Winter4,
  11. Barbara J M Mulder4,
  12. Michiel Voskuil1
  1. 1 Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
  3. 3 Netherlands Heart Institute, Utrecht, The Netherlands
  4. 4 Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Timion A Meijs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; T.A.Meijs-5{at}umcutrecht.nl

Abstract

Objective Long-term prognosis of patients with coarctation of the aorta (CoA) is impaired due to the high prevalence of hypertension and consequent cardiovascular complications. Although stent implantation results in acute anatomical and haemodynamic benefit, limited evidence exists regarding the late clinical outcome. In this meta-analysis, we aimed to evaluate the medium-term effect of stent placement for CoA on systemic blood pressure (BP).

Methods PubMed, EMBASE and Cochrane databases were searched for non-randomised cohort studies addressing systemic BP ≥12 months following CoA stenting. Meta-analysis was performed on the change in BP from baseline to last follow-up using a random-effects model. Subgroup analyses and meta-regression were conducted to identify sources of heterogeneity between studies.

Results Twenty-six studies with a total of 1157 patients and a median follow-up of 26 months were included for final analysis. Meta-analysis showed a 20.3 mm Hg (95% CI 16.4 to 24.1 mm Hg; p<0.00001) reduction in systolic BP and an 8.2 mm Hg (12 studies; 95% CI 5.2 to 11.3 mm Hg; p<0.00001) reduction in diastolic BP. A concomitant decrease in the use of antihypertensive medication was observed. High systolic BP and peak systolic gradient at baseline and stenting of native CoA were associated with a greater reduction in systolic BP at follow-up.

Conclusions Stent implantation for CoA is associated with a significant decline in systolic and diastolic BP during medium-term follow-up. The degree of BP reduction appears to be dependent on baseline systolic BP, baseline peak systolic gradient, and whether stenting is performed for native or recurrent CoA.

  • aortic coarctation
  • endovascular procedures for aortic and vascular disease
  • hypertension
  • meta-analysis
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Footnotes

  • Contributors Conception and design of the research: TAM and MV. Selection of studies, data extraction and risk of bias assessment: TAM, EW and MV. Analysis and interpretation of the extracted data: TAM, MGS and MV. Drafting of the manuscript and critical appraisal: TAM, EW, MGS, GJK, MMCM, FM, GTS, PD, BJB, RdW, BJMM and MV. Approval of the final version: TAM, EW, MGS, GJK, MCMM, FM, GTS, PD, BJB, RdW, BJMM and MV. Guarantor: TAM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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