Frequency and predictors of renal artery stenosis in patients with coronary artery disease |
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| Authors: | Romain Ollivier Dominique Boulmier David Veillard Guillaume Leurent Stéphane Mock Marc Bedossa Hervé Le Breton |
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| Affiliation: | 1. INSERM, U642, Rennes, F-35000, France;2. Université de Rennes 1, LTSI, Rennes, F-35000, France;3. CHU de Rennes, Service de cardiologie et maladies vasculaires, Rennes, F-35000, France;4. INSERM, CIC-IT 804, Rennes, F-35000;5. CHU Rennes, Service de santé publique, Rennes, F-35000, France;1. Department of Cardiology, Medical University of Wroclaw, Wroclaw, Poland;2. Department of Internal Diseases and Hypertension, Medical University of Wroclaw, Wroclaw, Poland;3. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland;4. Research and Development Center, Regional Specialist Hospital, Wroclaw, Poland;1. Vascular Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, United Kingdom;2. Central Manchester NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom;3. United States Renal Data System, Minneapolis, MN;1. Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA;2. Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA;3. Department of Medicine, Harvard Clinical Research Institute, Boston, MA, USA;4. Department of Medicine, University of Michigan, Ann Arbor, MI, USA;5. The University of Texas Health Science Center, San Antonio, TX, USA;6. Department of Medicine, Salford Royal Hospital NHS Foundation Trust, Greater Manchester, United Kingdom;7. Sunnybrook and Women''s College Health Sciences Centre, Toronto, Canada;8. Department of Radiology, Alfred Hospital, Melbourne, Australia;9. Department of Radiology, Auckland City Hospital, Auckland, New Zealand;10. Department of Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa;11. Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina |
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| Abstract: | BackgroundRenal artery stenosis (RAS) remains underdiagnosed because of nonspecific clinical manifestations, including in patients with coronary artery disease (CAD).AimsTo estimate the prevalence and identify predictors of RAS in patients with CAD undergoing coronary angiography.SettingUniversity-based medical centre.MethodsWe enrolled 650 consecutive patients (mean age=67±10 years, 80% men) with confirmed CAD. All patients underwent selective renal arteriography in the same procedure.We estimated the prevalence of RAS, defined as a >50% lesion. Multiple variable analysis of factors associated with presence of RAS was carried out using a logistic regression model. Variables that emerged as predictors by single-variable analysis were included in the model, along with variables that were tentatively associated with RAS, based on a literature review.ResultsRAS was detected in 94 patients (14.5%, 95% CI: 11.8–17.2%), including 20 (3.1%) with bilateral lesions. By single-variable analysis and presence and number of coronary artery stenoses (P<.001), hypertension (P=.001), and creatinine clearance <90 ml/min (P<.001) were associated with an increased risk of RAS. By multiple variable analysis, male sex (P<.05), presence and number of coronary artery lesions (P<.01), hypertension (P=.001), and renal insufficiency (P<.001) predicted the presence of RAS.ConclusionsThe main clinical predictors of RAS in patients with CAD were hypertension, renal insufficiency, and multivessel CAD. These observations might help defining a high-risk subgroup of patients in need of meticulous investigations of both CAD and RAS. |
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