Athanasios Saratzis1, Ioannis Paraskevopoulos2, Sanjay Patel3, Tommaso Donati3, Lukla Biasi3, Athanasios Diamantopoulos3, Hany Zayed3, Konstantinos Katsanos4. 1. Department of Vascular Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: saratzis@doctors.net.uk. 2. Department of Radiology, Royal Infirmary Hospital, Aberdeen, United Kingdom. 3. Department of Vascular Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom. 4. Patras University Hospital, Patras, Greece.
Abstract
OBJECTIVES: The aim of this study was to perform a comprehensive meta-analysis comparing all therapeutic modalities for intermittent claudication (IC), including best medical therapy (BMT) alone, percutaneous angioplasty (PTA), supervised exercise therapy (SET), and PTA combined with SET, to establish the optimal first-line treatment for IC. BACKGROUND: IC is a common health problem that limits physical activity, results in decreased quality of life (QoL) and is associated with poor cardiovascular outcomes. Previous meta-analyses have attempted to combine data from randomized trials; however, none have combined data from all possible treatment combinations or synthesized QoL outcomes. METHODS: Following a systematic review of the published research (conducted in December 2018) that identified 37 published randomized trials, a network meta-analysis was performed combining all possible IC treatment strategies. RESULTS: Overall, 2,983 patients with IC were included (mean weighted age 68 years, 54.5% men). Comparisons were performed between BMT (n = 688, 28 arms) versus SET (n = 1,189, 35 arms) versus PTA (n = 511, 12 arms) versus PTA plus SET (n = 395, 8 arms). Mean weighted follow-up was 12 months (95% confidence interval: 9 to 23 months). Compared with BMT alone, PTA plus SET outperformed other treatment strategies, with a maximum walking distance gain of 290 m (95% credible interval: 180 to 390 m; p < 0.001). A variety of QoL assessments using validated tools were reported in 15 trials; PTA plus SET was superior to other treatments (Cohen's D = 1.8; 95% credible interval: 0.21 to 3.4). CONCLUSIONS: In addition to BMT, PTA combined with SET seems to be the optimal first-line treatment strategy for IC in terms of maximum walking distance and QoL improvement.
OBJECTIVES: The aim of this study was to perform a comprehensive meta-analysis comparing all therapeutic modalities for intermittent claudication (IC), including best medical therapy (BMT) alone, percutaneous angioplasty (PTA), supervised exercise therapy (SET), and PTA combined with SET, to establish the optimal first-line treatment for IC. BACKGROUND: IC is a common health problem that limits physical activity, results in decreased quality of life (QoL) and is associated with poor cardiovascular outcomes. Previous meta-analyses have attempted to combine data from randomized trials; however, none have combined data from all possible treatment combinations or synthesized QoL outcomes. METHODS: Following a systematic review of the published research (conducted in December 2018) that identified 37 published randomized trials, a network meta-analysis was performed combining all possible IC treatment strategies. RESULTS: Overall, 2,983 patients with IC were included (mean weighted age 68 years, 54.5% men). Comparisons were performed between BMT (n = 688, 28 arms) versus SET (n = 1,189, 35 arms) versus PTA (n = 511, 12 arms) versus PTA plus SET (n = 395, 8 arms). Mean weighted follow-up was 12 months (95% confidence interval: 9 to 23 months). Compared with BMT alone, PTA plus SET outperformed other treatment strategies, with a maximum walking distance gain of 290 m (95% credible interval: 180 to 390 m; p < 0.001). A variety of QoL assessments using validated tools were reported in 15 trials; PTA plus SET was superior to other treatments (Cohen's D = 1.8; 95% credible interval: 0.21 to 3.4). CONCLUSIONS: In addition to BMT, PTA combined with SET seems to be the optimal first-line treatment strategy for IC in terms of maximum walking distance and QoL improvement.
Authors: Minakshi P Biswas; Warren H Capell; Mary M McDermott; Donald L Jacobs; Joshua A Beckman; Marc P Bonaca; William R Hiatt Journal: JACC Basic Transl Sci Date: 2021-02-22
Authors: Zhe Li; Erin K Englund; Michael C Langham; Jinchao Feng; Kebin Jia; Thomas F Floyd; Arjun G Yodh; Wesley B Baker Journal: Metabolites Date: 2021-11-29