Abstract 14713: Renal Denervation: Impact on Non-ST Segment Elevation Myocardial Infarction Rates in Patients With Hypertensive Heart Disease

Abstract

Introduction: Catheter-based renal denervation (RDN) is an emerging therapy for hypertension, with potential ancillary benefits, e.g. a decrease in atrial fibrillation. Little is known about its effects on coronary artery disease (CAD) and acute coronary syndromes (ACS), e.g. non-ST segment elevation myocardial infarction (NSTEMI). Hypothesis: RDN reduces the incidence of NSTEMI in patients with hypertension and CAD. Methods: Data were retrospectively analyzed from the Renal Sympathetic Denervation Prevents Atrial Fibrillation in Patients with Hypertensive Heart Disease (RDPAF) trial (NCT01990911), which prospectively randomized individuals with uncontrolled hypertension and hypertensive heart disease to RDN or sham procedure groups in a 1:1 fashion. All patients required an indication for invasive coronary angiography. The impact of RDN on incident NSTEMI was evaluated with a log-rank test. Results: A total of 80 patients (mean age 65±8 years, 73% male) were analyzed: 42 (53%) patients underwent RDN, while 38 (47%) received sham-RDN. Baseline characteristics did not differ between groups: 54% of the total study population had diabetes mellitus, 88% took statins, 13% were current smokers and 68% had established CAD. After a mean follow-up of 38±23 months, 9 (11%) patients experienced a NSTEMI: 1 RDN (2.38%) vs 8 sham patients (21%) (OR: 0.092; 95% CI: 0.01 to 0.77; p=0.009; figure). Office systolic blood pressures decrease after six months’ follow-up did not differ between groups (-12.88mmHg in RDN vs. -9.13 mmHg in sham group; p= 0.49). Conclusions: Hypertensive patients who underwent RDN experienced a lower rate of NSTEMI during long term follow-up, compared to a sham-RDN control group. This may signal a novel benefit of RDN, i.e. a reduction in the incidence of ACS. Larger, prospective studies are needed to test this hypothesis and unravel potential protective mechanisms of RDN.