• Agnieszka Rosławiecka, Anna Kabłak-Ziembicka, Daniel Rzeźnik, Piotr Pieniążek, Rafał Badacz, Mariusz Trystuła, and Tadeusz Przewłocki.
• Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
• Pol. Arch. Med. Wewn. 2019 Nov 29; 129 (11): 747-760.

IntroductionThe effect of stent‑assisted percutaneous transluminal angioplasty (PTA) for renal artery stenosis (RAS) on systolic (SBP) and diastolic blood pressure (DBP) as well as renal function, in comparison with medical therapy, is still debatable. Data on determinants of cardiovascular (CV) outcome after PTA are lacking.ObjectivesWe aimed to identify determinants of major cardiac and cerebral events (MACCEs) following PTA for RAS.Patients And MethodsA total of 248 PTAs for RAS were performed in 211 patients with difficult‑to‑treat hypertension and/or progressive renal impairment. The primary outcomes were procedural success, in‑hospital complications, renal function (estimated glomerular filtration rate [eGFR]), change in SBP or DBP, and an incidence of MACCEs during a median of 47 months (interquartile range [IQR], 18-78 months).ResultsProcedural success and complication rates were 99.2% and 4.7%, respectively. We observed significant differences in SBP, DBP, and eGFR at 12 months as compared with baseline. A total of 63 MACCEs (30.6%) were noted in 206 patients with available follow‑up data. The receiver operating characteristic curve analysis indicated the following best cutoff values for the risk of CV death: an increase in eGFR by at least 11 ml/min/1.73 m2 and a decrease in SBP and DBP by at least 20 mm Hg and 5 mm Hg, respectively. At 12‑month follow‑up, an increase in eGFR of at least 11 ml/min/1.73 m2 was independently associated with a reduced risk of death (hazard ratio [HR], 0.42; 95% CI, 0.19-0.90; P = 0.02) and MACCEs (HR, 0.54; 95% CI, 0.32-0.93; P = 0.03), while a decrease of DBP by 5 mm Hg or higher, with a reduced risk of stroke (HR, 0.1; 95% CI, 0.02-0.39; P = 0.001).ConclusionsThis study confirms the efficacy and safety of PTA as well as its significant effect on changes in blood pressure and eGFR values. Patients with an increase in eGFR of at least 11 ml/min/1.73 m2 have a significant risk reduction of MACCEs and CV death, while those with a decrease in DBP of at least 5 mm Hg, of stroke.

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