Abstract 14326: Temporal Trends in Renal Artery Stenting Among Older Patients in the United States
William B Earle, Siling Li, Yang Song, Anna Krawisz, Jennifer Cluett, Herbert D Aronow, Sahil A Parikh, Brett Carroll, Eric A Secemsky- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: There is mixed evidence to support renal artery (RA) stenting for improvement in blood pressure control or reduction in cardiovascular and renal events, yet it remains a treatment option in specific clinical scenarios. Contemporary procedural rates and outcomes have been incompletely evaluated.
Objective This study aims to describe temporal trends in RA stenting and outcomes among older US patients.
Methods: Fee-for-service Medicare beneficiaries age over 65 years, with >1 year of enrollment in Medicare, who underwent RA stenting between January 1, 2016 and December 31, 2020 were included. Outcomes included: (i) a composite of hospitalization for hypertensive urgency, stroke, or myocardial infarction (MI), (ii) new initiation of dialysis, and (iii) need for repeat RA stenting. The cumulative incidence function was used to estimate the incidence of outcomes, accounting for the competing risk of death.
Results: A total of 31,359 were included: 55.7% female, average age 75.7 ±6.4 years, 88.9% white and 6.6% black. Among the study sample, 75.9% had chronic kidney disease (CKD), 98.2% had hypertension, and 80.9% had ischemic heart disease. Between 2016-2020, the incidence of RA stenting decreased annually from 27.3 to 15.9 per 100,000 Medicare beneficiaries. The 1-year post-procedure incidence of MI was 4.0%, stroke 2.6%, hypertensive urgency 4.6%, dialysis initiation 2.1% and repeat RA stenting 4.6%. Adverse events occurred more frequently among older patients, Black patients, those whom the indication for RA stenting was cardiovascular disease or CKD, and patients enrolled in both Medicare and Medicaid. ( Fig. 1 )
Conclusion: RA stenting rates in the US are declining, yet it is still frequently used in clinical practice. Post-procedure cardiovascular and renal events are infrequent, but their incidence varies by patient population. Further investigation is warranted to evaluate the risks and benefits of this procedure in specific patient populations.