Relationship of Albuminuria and Renal Artery Stent Outcomes: Results From the CORAL Randomized Clinical Trial (Cardiovascular Outcomes With Renal Artery Lesions)

Murphy, Timothy P.; Cooper, Christopher J.; Pencina, Karol M.; D’Agostino, Ralph; Massaro, Joseph; Cutlip, Donald E.; Jamerson, Kenneth; Matsumoto, Alan H.; Henrich, William; Shapiro, Joseph I.; Tuttle, Katherine R.; Cohen, David J.; Steffes, Michael; Gao, Qi; Metzger, D. Christopher; Abernethy, William B.; Textor, Stephen C.; Briguglio, John; Hirsch, Alan T.; Tobe, Sheldon; Dworkin, Lance D.

doi:10.1161/hypertensionaha.116.07744

Cited by 69Renal and Vascular PathologiesPeripheral Artery Disease ManagementCerebrovascular and Carotid Artery Diseases

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Relationship of Albuminuria and Renal Artery Stent Outcomes: Results From the CORAL Randomized Clinical Trial (Cardiovascular Outcomes With Renal Artery Lesions)

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Murphy, Timothy P., Cooper, Christopher J., Pencina, Karol M., D’Agostino, Ralph, Massaro, Joseph, Cutlip, Donald E., Jamerson, Kenneth, Matsumoto, Alan H., Henrich, William, Shapiro, Joseph I., Tuttle, Katherine R., Cohen, David J., Steffes, Michael, Gao, Qi, Metzger, D. Christopher, Abernethy, William B., Textor, Stephen C., Briguglio, John, Hirsch, Alan T., Tobe, Sheldon, Dworkin, Lance D.·2016·Hypertension

DOI 10.1161/hypertensionaha.116.07744PMC PMC5634521

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Abstract

Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease– or kidney disease–related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P =0.02), cardiovascular disease–related death (93% versus 85%; P ≤ 0.01), progressive renal insufficiency (91% versus 77%; P =0.03), and overall survival (89% versus 76%; P ≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations. Clinical Trial Registration—: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00081731.

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Post hoc analysis of the CORAL trial data suggests a mortality benefit of revascularization compared with medical therapy for atherosclerotic renal artery stenosis in patients without proteinuria.
“Post hoc analysis of the CORAL trial (Cardiovascular Outcomes With Renal Artery Lesions) data suggests a mortality benefit of revascularization compared with medical therapy for atherosclerotic renal artery stenosis in patients without proteinuria.315”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [315]

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Authors: Murphy, T. P., Cooper, C. J., Pencina, K. M., D’Agostino, R., Massaro, J., Cutlip, D. E., Jamerson, K., Matsumoto, A. H., Henrich, W., Shapiro, J. I., Tuttle, K. R., Cohen, D. J., Steffes, M., Gao, Q., Metzger, D. C., Abernethy, W. B., Textor, S. C., Briguglio, J., Hirsch, A. T., Tobe, S., & Dworkin, L. D.
Affiliations: Beth Israel Deaconess Medical Center (US)
ORCID: Murphy, Timothy P.
Cooper, Christopher J.
Pencina, Karol M.
D’Agostino, Ralph
Massaro, Joseph
Cutlip, Donald E.
Jamerson, Kenneth
Matsumoto, Alan H.
Tuttle, Katherine R.
Cohen, David J.
Gao, Qi
Tobe, Sheldon
Dworkin, Lance D.
Venue: Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-11
Volume: 68
Issue: 5
Pages: 1145-1152
ISSN: 0194-911X (ISSN-L)
1524-4563
DOI: 10.1161/hypertensionaha.116.07744
PMC: PMC5634521
OpenAlex: W2522461160
Cited by: 69
References: 41
Citations by year: 2026: 5 · 2025: 5 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 10 · 2019: 11 · 2018: 7 · 2017: 5 · 2016: 1
FWCI: 7.15
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Hypertension (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Pfizer
AstraZeneca
National Institutes of Health (7r01hl109015-04)
National Heart, Lung, and Blood Institute (U01HL072735, R01HL-109015, U01HL071556, U01HL072737, U01HL072734, U01HL072736)
Cordis
Topics: Health Sciences › Medicine › Nephrology › Renal and Vascular Pathologies
Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords: albuminuria, renal artery stenting, renal artery stenosis, urine albumin-creatinine ratio, event-free survival, progressive renal insufficiency, renal replacement therapy, overall survival, optimal medical therapy, subgroup analysis
MeSH terms: Aged, Albuminuria, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Renal Artery Obstruction, Severity of Illness Index, Vasodilator Agents, Stents, Comorbidity, Survival Rate, Confidence Intervals, Treatment Outcome, Risk Assessment, Kaplan-Meier Estimate

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Relationship of Albuminuria and Renal Artery Stent Outcomes: Results From the CORAL Randomized Clinical Trial (Cardiovascular Outcomes With Renal Artery Lesions)

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