Time to Benefit of Surgery vs Targeted Medical Therapy for Patients With Primary Aldosteronism: A Meta-analysis
Authors' conclusion
Surgery is associated with lower all-cause mortality and MACE than medical therapy for PA. For most patients, the long-term surgical benefits outweigh the short-term perioperative risks.
Study context
- Population
- Patients with primary aldosteronism (PA); studies from Medline and EMBASE
- Participants
- 15,541 patients16 studies
- Comparison
- Adrenalectomy vs medical therapy
- Outcome
- Death and MACE
Methodological detailsrandom-effects models, time to benefit meta-analysis (Weibull survival curves), two independent reviewers
- Random-effects models
- Time to benefit meta-analysis (Weibull survival curves)
- Two independent reviewers
Pooled result
As reported in the abstract
Surgery vs Medical therapyHazard ratio (95% CI)
Death
0.34(0.22–0.54)
MACE
0.55(0.36–0.84)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Hospitalization for HF | 0.48 (0.34–0.70) | |
| Progression to CKD | 0.62 (0.39–0.98) | |
| 0.20.5125Hazard ratio (log scale) |
MI and stroke
- Nonsignificant reductions in MI and stroke with surgery
Time to benefit for death
- Patients treated with surgery instead of medical therapy to prevent 1 death
- 200
- Time to benefit (months)
- 12.3 (95% CI 3.1-48.7)
Original publication
Time to Benefit of Surgery vs Targeted Medical Therapy for Patients With Primary Aldosteronism: A Meta-analysis. J Clin Endocrinol Metab. Published 8 November 2023. doi:10.
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