title: Revascularization of atherosclerotic renal artery stenosis for chronic heart failure versus acute pulmonary oedema.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  There were 152 patients: 59% male, 36% diabetic, age 70 ± 9 years, estimated glomerular filtration rate 29 ± 17 mL/min per 1.73 m2; 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).
  
  
  CONCLUSIONS
  The benefit of revascularization in heart failure may extend beyond the current indication of acute pulmonary oedema. However, findings derive from an observational study.
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Vascular Research Group, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK.
authors.forename: James P
authors.initials: JP
authors.lastname: Ritchie
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK.
authors.forename: Constantina
authors.initials: C
authors.lastname: Chrysochou
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.|Vascular Research Group, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D059347:Cardio-Renal Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: atherosclerosis; chronic kidney disease; heart failure; hypertension; renal artery stenosis