Meta-Analysis Supports PTA Plus Supervised Exercise Therapy as Optimal First-Line Treatment for Intermittent Claudication

June 28, 2019—Findings from a comprehensive meta-analysis comparing all therapeutic modalities for intermittent claudication (IC) to establish the optimal first-line treatment for IC were published by Athanasios Saratzis, MBBS, PhD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions. The therapeutic modalities included best medical therapy (BMT) alone, percutaneous angioplasty (PTA), supervised exercise therapy (SET), and PTA combined with SET.

The investigators noted that IC limits physical activity, results in decreased quality of life (QOL), and is associated with poor cardiovascular outcomes. Although previous meta-analyses have attempted to combine data from randomized trials, none have combined data from all possible treatment combinations or synthesized QOL outcomes.

As summarized in JACC: Cardiovascular Interventions, a systematic review of the published research was conducted in December 2018 that identified 37 published randomized trials. Then, a network meta-analysis was performed combining all possible IC treatment strategies. The study was composed of 2,983 patients with IC (mean weighted age 68 years; 54.5% men).

Comparisons were performed between BMT (688 patients, 28 arms) versus SET (1,189 patients, 35 arms) versus PTA (511 patients, 12 arms) versus PTA plus SET (395 patients, 8 arms). Mean weighted follow-up was 12 months (95% confidence interval, 9 to 23 months).

The investigators found that 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 < .001). A variety of QOL assessments using validated tools were reported in 15 trials that showed PTA plus SET was superior to other treatments (Cohen’s d = 1.8; 95% credible interval, 0.21 to 3.4).

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, concluded the investigators in JACC: Cardiovascular Interventions.