RT Journal Article
SR Electronic
T1 Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1464
OP 1470
DO 10.1136/heartjnl-2019-314965
VO 105
IS 19
A1 Timion A Meijs
A1 Evangeline G Warmerdam
A1 Martijn G Slieker
A1 Gregor J Krings
A1 Mirella M C Molenschot
A1 Folkert J Meijboom
A1 Gertjan T Sieswerda
A1 Pieter A Doevendans
A1 Berto J Bouma
A1 Robbert J de Winter
A1 Barbara J M Mulder
A1 Michiel Voskuil
YR 2019
UL http://heart.bmj.com/content/105/19/1464.abstract
AB 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.