LONG-TERM SYSTEMIC BLOOD PRESSURE AFTER ENDOVASCULAR STENTING OF AORTIC COARCTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background Although stent implantation for aortic coarctation (CoA) is associated with acute anatomical and hemodynamic benefit, limited evidence exists regarding the late impact on blood pressure and cardiovascular complications. In this meta-analysis we aimed to evaluate the influence of stent placement for CoA on long-term systemic blood pressure. Methods PubMed, EMBASE, and Cochrane Library were searched to identify studies reporting on mean systolic blood pressure (SBP) before and at least 12 months after stent implantation. Meta-analysis was performed on the absolute change from baseline to last follow-up using a random-effects model. Results Twenty-six studies with a total of 1,157 patients were included for final analysis. Meta-analysis showed a 20.3 mmHg (95% confidence interval (CI) 16.4-24.1 mmHg; P < 0.00001) reduction in SBP. Previous CoA correction, age < 18 years, and lower baseline SBP were identified as risk factors for a less significant decrease in SBP. A concomitant 8.2 mmHg (12 studies; 95% CI 5.2-11.3 mmHg; P < 0.00001) reduction in diastolic blood pressure (DBP) was observed. Sensitivity analyses and adjustment for suspected publication bias did not modify the overall outcome. Conclusion Endovascular stenting as a treatment for CoA is associated with a significant decline in both SBP and DBP during long-term follow-up and may consequently reduce the risk of future adverse cardiovascular events.