Long-term mortality rate after supervised exercise therapy versus early revascularization for intermittent...

Area of Science:

• Vascular Surgery
• Clinical Medicine
• Evidence-Based Medicine

Background:

• Supervised Exercise Therapy (SET) is a recommended first-line treatment for intermittent claudication.
• Oxidative stress from chronic leg ischemia may negatively impact outcomes.
• Revascularization is hypothesized to mitigate risks associated with long-term ischemia.

Purpose of the Study:

• To systematically review and meta-analyze long-term mortality rates and clinical outcomes.
• To compare Supervised Exercise Therapy (SET) with early revascularization in intermittent claudication patients.
• To evaluate the hypothesis that revascularization mitigates risks from long-term ischemia.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) with >12 months follow-up.
• Inclusion criteria focused on studies reporting mortality rates comparing SET and early revascularization.
• Risk-of-bias assessment using the Cochrane Risk-of-Bias Tool; meta-analyses employed hazard ratios, incidence rate ratios (IRR), or odds ratios.

Main Results:

• Meta-analysis of two cohorts showed higher mortality with SET (HR: 1.83; P = 0.02).
• Sensitivity analysis indicated higher mortality with SET (IRR: 1.29; P = 0.02).
• SET reduced initial revascularizations but led to over double the need for subsequent procedures (OR: 2.30; P < 0.001). No differences in amputation, MI, or stroke.
• Certainty of evidence was low to very low due to high risk-of-bias.

Conclusions:

• Early revascularization may offer improved long-term survival compared to SET for intermittent claudication.
• Interpretation of findings is constrained by study limitations, including risk-of-bias and incomplete data.
• Further high-quality research is needed to definitively compare these treatment strategies.