Author + information
- Received December 10, 2018
- Revision received February 5, 2019
- Accepted February 12, 2019
- Published online June 17, 2019.
- Athanasios Saratzis, MBBS, PhDa,∗ (, )
- Ioannis Paraskevopoulos, MD, PhDb,
- Sanjay Patel, BSc (Hons), MBChB, MD (Res)a,
- Tommaso Donati, BSc, MDa,
- Lukla Biasi, MDa,
- Athanasios Diamantopoulos, MD, PhDa,
- Hany Zayed, MD, MSca,∗ and
- Konstantinos Katsanos, MSc, MD, PhDc,∗
- aDepartment of Vascular Surgery, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
- bDepartment of Radiology, Royal Infirmary Hospital, Aberdeen, United Kingdom
- cPatras University Hospital, Patras, Greece
- ↵∗Address for correspondence:
Dr. Athanasios Saratzis, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, Department of Vascular Surgery, 1 Westminster Bridge Road, London SE1 9RT, United Kingdom.
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.
↵∗ Drs. Zayed and Katsanos are joint senior authors.
Dr. Saratzis is partly funded by the National Institute for Health Research and the Academy of Medical Sciences; and also receives honoraria and reimbursements from Amgen, Regeneron, and Medyria Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 10, 2018.
- Revision received February 5, 2019.
- Accepted February 12, 2019.
- 2019 American College of Cardiology Foundation
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