Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease

Weber-Mzell, Daniela; Kotanko, Peter; Schumacher, M.; Klein, W.; Skrabal, F.

doi:10.1053/euhj.2002.3314

Cited by 116 publications

(39 citation statements)

References 21 publications

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“…The relationship between extent of CAD and RAS has been previously evaluated in elective patients37: the number of diseased coronary arteries roughly multiplies by 5 the prevalence of RAS 5. In our study, the degree of CAD was a strong predictor for RAS in multivariate analysis, reflecting progressive stages of multisite disease.…”

Section: Discussionmentioning

confidence: 48%

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Burlacu¹,

Siriopol

Voroneanu

et al. 2015

JAHA

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BackgroundWe are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI.Methods and ResultsOne hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity.ConclusionsWe observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.

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Section: Discussionmentioning

confidence: 48%

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Burlacu¹,

Siriopol

Voroneanu

et al. 2015

JAHA

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“…The literature has extensively reported a high prevalence of unsuspected RAS in patients undergoing coronary angiography: it increased from 7 to 22% in patients with CAD and is much higher in patients with hypertension and an impaired renal function [1,2,3,4,5,6,7] and in patients with established CAD, particularly in those with three-vessel disease. The prevalence of the association of CAD with RAS in patients undergoing coronary angiography having other risk factors ranges from 11 to 18% [8, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…Although the prevalence of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) has been extensively studied [1,2,3,4,5,6,7,8,9,] as well as the predictors of technical success of renal angioplasty and stenting have been well described [10,11,12], the angiographic characteristics of RAS in patients with clinically significant CAD have not been yet fully investigated. We sought to retrospectively evaluate the angiographic characteristics of RAS in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

Angiographic Characteristics of Renal Arterial Disease over the Spectrum of Coronary Artery Disease

Rigatelli¹,

Roncon²,

Rinuncini³

et al. 2005

Am J Nephrol

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Background/Aim: The angiographic characteristics of renal artery stenoses (RAS) in patients with coronary artery disease (CAD) have not been yet fully investigated. We sought to evaluate the angiographic characteristics of RAS in patients with CAD. Methods: The medical records of consecutive patients who underwentcoronary angiography in a single public institution over a 12-month period were evaluated. The patients who underwent coincident diagnostic renal angiography to evaluate renal vessels on the basis of clinical criteria and who had at least one-vessel CAD were analyzed. Moderate (50–70%) to severe (70–100%) arterial stenoses were noted as significant angiographic findings. The types of stenosis (ostial, true renal, mixed) and presence and location of calcium were recorded. Results: Angiographically significant RAS were reported in 40 (19.5%) of 205 consecutive patients (mean age 67.1 ± 12.8 years, mean serum creatinine concentration 2.1 ± 0.5 mg/dl, mean glomerular filtration rate 52 ± 13 ml/min) for a total of 55 lesions. The RAS severity was moderate in 30.9% (17/55), severe in 69.1% (38/55), ostial in 27.2% (15/55), true renal in 10.9% (6/55), and mixed in 61.8% (34/55) of the patients. The mean lesion length was 16 ± 1.8 mm. Patients with ≧3-vessel CAD had a statistically significantly higher prevalence of mixed calcified RAS (18/24, 75%). Logistic regression analyses revealed ≧3-vessel CAD (odds ratio 9.917, p = 0.002), age >65 years (odds ratio 3.817, p = 0.036), and ≧3 risk factors (odds ratio 2.8, p = 0.048) as independent predictors of RAS. Conclusion: RAS in multivessel CAD patients seems to have a peculiar angiographic pattern, such as a higher prevalence of mixed calcified lesions and poststenotic enlargement, that should be taken in account when dealing with RAS.

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“…There are different opinions on whether hypertension is a risk factor of ARAS [7,8,9, 14, 15]. Holley et al [16].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Atherosclerotic Renal Artery Stenosis in 1,200 Chinese Patients Undergoing Coronary Angiography

Zhang¹,

Ge²,

Qian³

et al. 2006

Nephron Clin Pract

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Aims: Atherosclerotic renal artery stenosis (ARAS) is a common and potentially reversible cause of end-stage renal failure. Our study aimed to determine the prevalence and predictors of ARAS in Chinese patients undergoing coronary angiography for suspected coronary heart disease (CAD), or for acute or chronic myocardial infarction. Methods: Selective renal arteriography was performed immediately after coronary angiography in 1,200 consecutive patients. Medical history and laboratory data were obtained before the procedure. Significant renal artery stenosis was defined as ≧50% narrowing of the luminal diameter. Uni- and multivariate logistic regression analyses were made to explore the association of the clinical and laboratory variables, including some items which had never or rarely been studied, with ARAS or CAD. Results: Of the 1,200 patients, 840 were male and 360 female. Their mean age was 62 ± 10 years. Low-grade (<50%) and significant coronary artery stenosis was found in 108 (9%) and 610 (51%) patients respectively. By multivariate logistic regression analysis, risk factors associated with the presence of coronary artery stenosis included male, older age, smoking, high serum concentration of low density lipoprotein, lipoprotein (a), and fast blood glucose ≧7.0 mmol/l. Significant ARAS was present in 116 (9.7%) patients, of which 20 (1.7%) were bilateral. The incidence of ARAS was similar in patients with suspected CAD or myocardial infarction. Multivariate logistic regression analysis showed the association of the clinical variables with ARAS included: older age, hypercholesterolemia, a more than 10-year history of hypertension, proteinuria and S_Cr ≧133 µmol/l. The severity of ARAS is significantly related to the severity of coronary artery disease. Conclusion: ARAS is a frequent finding in Chinese patients undergoing coronary angiography, especially in patients with significant coronary artery stenosis and risk factors for ARAS. Renal arteriography can be a helpful examination in these patients.

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Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease

Abstract: Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.

Cited by 116 publications

References 21 publications

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Angiographic Characteristics of Renal Arterial Disease over the Spectrum of Coronary Artery Disease

Prevalence and Risk Factors of Atherosclerotic Renal Artery Stenosis in 1,200 Chinese Patients Undergoing Coronary Angiography

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