Evidence map›Paper›PMID 28385410›Full record

ReviewJACC. Cardiovascular interventions2017

Comparative Efficacy of Endovascular Revascularization Versus Supervised Exercise Training in Patients With Intermittent Claudication: Meta-Analysis of Randomized Controlled Trials.

Ambarish Pandey, Subhash Banerjee, Christian Ngo, Purav Mody, Steven P Marso, Emmanouil S Brilakis, Ehrin J Armstrong, Jay Giri, Marc P Bonaca, Aruna Pradhan and 2 more

Abstract readReview
PubMed Publisher
In one paragraph

Review in JACC. Cardiovascular interventions, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  19. Exercise Therapy in the Management of Peripheral Arterial Disease.Mayo Clinic proceedings. Innovations, quality & outcomes · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Ambarish PandeyDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Subhash BanerjeeDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Christian NgoDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Purav ModyDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Steven P MarsoDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Emmanouil S BrilakisDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Ehrin J ArmstrongSection of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Denver, Colorado.
Jay GiriCardiovascular Medicine Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Marc P BonacaDivsion of Cardiovasular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Aruna PradhanDivsion of Cardiovasular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Anthony A BavryDepartment of Medicine, University of Florida, Gainesville, Florida.
Dharam J KumbhaniDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: dharam@post.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe authors performed a meta-analysis of randomized controlled trials to compare the efficacy of initial endovascular treatment with or without supervised exercise training (SET) versus SET alone in patients with intermittent claudication.

backgroundCurrent guidelines recommend SET as the initial treatment modality for patients with intermittent claudication, in addition to optimal medical therapy. The role of endovascular therapy as primary treatment for claudication has been controversial.

methodsThe primary outcome was treadmill-measured maximal walk distance at the end of follow-up. Secondary outcomes included resting ankle brachial index (ABI) and treadmill-measured ischemic claudication distance on follow-up. Risk of revascularization or amputations was also compared. Pooled estimates of the difference in outcomes between endovascular therapy with or without SET and SET-only groups were calculated using fixed and random effects models.

resultsA total of 987 patients from 7 trials were included. In pooled analysis, compared with SET only (reference group), patients that underwent combined endovascular therapy and SET had significantly higher maximum walk distance (standardized mean difference 0.79 [95% confidence interval (CI): 0.18 to 1.39]; weighted mean difference 98.9 [95% CI: 31.4 to 166.4 feet], and lower risk of revascularization or amputation (odds ratio 0.19 [95% CI: (0.09 to 0.40]; p < 0.0001, number needed to treat = 8) over a median follow-up of 12.4 months. By contrast, revascularization was not associated with significant improvement in exercise capacity or risk of future revascularization or amputation, compared with SET alone. Follow-up ABI was significantly higher among patients that underwent endovascular therapy with or without SET as compared with SET alone.

conclusionsCompared with initial SET only, endovascular therapy in combination with SET is associated with significant improvement in total walking distance, ABI, and risk of future revascularization or amputation. By contrast, endovascular therapy-only was not associated with any improvement in functional capacity or clinical outcomes over an intermediate duration of follow-up.

Indexed as

Endovascular ProceduresExercise TherapyExercise ToleranceAgedAmputation, SurgicalAnkle Brachial IndexCombined Modality TherapyEvidence-Based MedicineExercise TestFemaleHumansIntermittent ClaudicationLimb SalvageMaleMiddle AgedOdds Ratioexercise capacityintermittent claudicationperipheral arterial diseaserevascularizationsupervised exercise training

Identifiers

PMID28385410

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.