Composite end point versus individualized care

In their careful analysis of the patients enrolled in the CORAL trial, 1 Modrall J.G. Zhu H. Weaver F.A. Clinical predictors of 2 blood pressure response following renal artery stenting. J Vasc Surg. 2020; 72: 1269-1275 Abstract Full Text Full Text PDF Scopus (3) Google Scholar Modrall et al were able to identify three clinical markers that provided a greater than 80% likelihood of positive response to renal artery stenting, with a significant long-term decrease in systolic and diastolic blood pressures, and perhaps more important with a decrease in antihypertensive medication. And yet, as with the overall CORAL trial, 2 Cooper C.J. Murphy T.P. Cutlip D.E. Jamerson K. Henrich W. Reid D.M. et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med. 2014; 370: 13-22 Crossref PubMed Scopus (614) Google Scholar no difference in composite end points of mortality or cardiovascular/renal morbidity could be demonstrated. Interestingly, a review by the original CORAL authors 3 Murphy T.P. Cooper C.J. Pencina K.M. D'Agostino R. Massaro J. Cutlip D.E. et al. Relationship of albuminuria and renal artery stent outcomes: results from the CORAL randomized clinical trial (Cardiovascular Outcomes With Renal Artery Lesions). Hypertension. 2016; 68: 1145-1152 Crossref PubMed Scopus (40) Google Scholar found albumin/creatinine ratios to be predictive of response to the same composite end point, a correlation not apparently present in this study, a cautionary tale for retrospective analysis. Clinical predictors of blood pressure response after renal artery stentingJournal of Vascular SurgeryVol. 72Issue 4PreviewThe Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, a multicenter randomized controlled trial, failed to demonstrate a benefit of renal artery stenting (RAS) over medical therapy in patients with renal artery stenosis and hypertension. However, there are patients for whom RAS is a consideration because of failure of medical therapy. Unfortunately, selection of patients for RAS is complicated by a lack of validated predictors of blood pressure (BP) response. A previous single-center study identified three preoperative markers of BP response to RAS: requirement for four or more antihypertensive medications, preoperative diastolic BP >90 mm Hg, and preoperative clonidine use. Full-Text PDF