Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Ollivier, Romain; Boulmier, Dominique; Veillard, D.; Leurent, Guillaume; Mock, Stéphane; Bédossa, Marc; Breton, Hervé

doi:10.1016/j.carrev.2008.06.003

Cited by 34 publications

(31 citation statements)

References 29 publications

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“…Similar differences in groups have been found in other studies. [11][12][13][14][15][16][17][18][19] The higher rate of RAS among patients with a history of CABG in our study and that of Cohen et al 19 reflects a higher prevalence among patients with multi-vessel CAD. This finding may certify that RAS is a manifestation of diffuse atherosclerosis and has a higher prevalence in those with CAD and PAD.…”

Section: Discussionmentioning

confidence: 70%

“…[7][8][9] The reported prevalence of significant RAS (X50%) among patients undergoing coronary angiography ranges from 6.2% to as high as 28%. 2,[8][9][10][11][12][13][14][15][16][17][18] A positive association between the presence and severity of RAS and CAD has been described, [11][12][13]16,18,19 and the presence of RAS has been associated with poor cardiovascular outcome. 9,[20][21][22] There is growing evidence that a high percentage of significant atherosclerotic RAS is clinically indolent.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

et al. 2009

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Renal artery stenosis (RAS) is a major comorbid condition in patients with coronary artery disease (CAD). Although the reported prevalence of significant RAS among patients undergoing coronary angiography varies from 6.2 to 28% in Western countries, little information is available on the prevalence and predictors of RAS in Middle Eastern countries. From April 2007 to May 2008, 732 hypertensive patients with suspected CAD immediately after selective coronary angiography underwent abdominal aortography with or without selective renal angiography. Coronary angiography revealed stenosis of X50% in at least one of the main coronary vessels in 434 (59.3%) patients, including 100 (13.7%) cases with single-vessel CAD, 114 (15.6%) with two-vessel CAD and 220 (30.1%) with three-vessel CAD. Significant RAS was present in 87 patients (11.9%), severe (X75%) RAS in 35 patients (4.8%) and bilateral RAS in 37 patients (5.1%). Higher serum creatinine level, severity of CAD, history of coronary artery bypass graft surgery (CABG), congestive heart failure, and pulmonary edema together with atrial fibrillation were the most powerful predictors of significant RAS. In multivariate logistic regression analysis, three-vessel CAD (odds ratio 1.61, 95% confidence interval (1.36-1.91), Po0.001), history of CABG (odds ratio 4.40, 95% confidence interval (1.17-16.5), P¼0.028) and serum creatinine level of 41.2 mg per 100 ml (odds ratio 2.12, 95% confidence interval (1.09-4.12), P¼0.026) were the most powerful predictors of significant RAS. The prevalence of RAS in our patients was similar to that reported in the Western countries. The presence of multi-vessel CAD or a history of CABG along with a higher serum creatinine level in hypertensive patients undergoing coronary angiography was found to be a risk factor for RAS.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

et al. 2009

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“…Atherosclerotic renovascular disease (ARVD) is frequently observed in conjunction with atherosclerosis in other vascular beds [2,3]. Renal artery stenosis is detectable in 5–20% of patients with coronary artery disease (CAD) undergoing cardiac catheterization [4–8], as both share risk factors and underlying pathogenesis. Complex interactions exist between atherothrombosis at various arterial locations.…”

Section: Introductionmentioning

confidence: 99%

Extrarenal atherosclerotic disease blunts renal recovery in patients with renovascular hypertension

Khangura

Eirin

Kane³

et al. 2014

Journal of Hypertension

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Background Atherosclerotic renovascular disease (ARVD) is associated with high rates of coronary events and predicts mortality among patients with coronary artery disease (CAD). However, the impact of coronary atherosclerosis on renal outcomes after revascularization of ARVD is unclear. We hypothesized that CAD negatively impacts renal functional outcomes among patients with ARVD undergoing renal artery revascularization. Methods Patients with ARVD who underwent echocardiography at Mayo Clinic, Rochester, Minnesota, USA between 2004 and 2012 were identified retrospectively and included if they had ejection fraction more than 50%. Renal and overall outcomes were compared among atherosclerotic renovascular disease patients with coronary artery disease (ARVD-C, n=75) and without coronary artery disease (ARVD, n=56), within 1 year from initial revascularization and included blood pressure control, renal function, and incident cardiovascular/cerebrovascular events. Results Degree of renal artery stenosis was similar in both groups. ARVD-C had higher prevalence of diabetes, peripheral artery disease (PAD), and cerebrovascular disease, and lower baseline renal function. Risk of developing end-stage renal disease was higher in ARVD-C (11 vs. 2%, P=0.05). Despite better control of blood pressure and cholesterol levels, renal function postrevascularization worsened in 15% of ARVD-C compared with 2% of ARVD (P=0.01). Differences in clinical outcomes remained statistically significant after adjustment for covariables, including sex, baseline blood pressure, renal function, underlying diabetes, cholesterol levels, and medications. Similar differences in clinical outcomes were also associated with PAD and cerebrovascular disease. Conclusion CAD in patients with ARVD is a predictor of worse outcomes after renal revascularization, likely reflecting diffuse atherosclerotic disease. Further studies are needed to develop strategies to manage patients with vascular comorbidities and improve their outcomes.

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“…Some factors like abdominal bruit, hypertension and smoking are reported as risk factors in anecdotal studies [40]. There are also controversies regarding the role of sex in predicting factor for RAS; while some researchers considered male sex as risk factor of RAS [48], some others reported that the prevalence of RAS is more in female [44,49,50]. These differences may be due to the different ethnicities of patients, as it has been shown that CAD, hypertension, diabetes and hyperlipidemia are more prevalent in Iranian women than men [51].…”

Section: Discussionmentioning

confidence: 99%

Development of a Simple Risk Score Model to Predict Renal Artery Stenosis

Khatami

Jalali

Zare

et al. 2018

Nephron

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Background/Aims: Renal artery stenosis (RAS) is a known cause of secondary hypertension and renal failure. Although renal artery angiography is the gold standard for diagnosing RAS, a simple method to estimate if patients will develop RAS is required. The aim of this retrospective study was to develop a simple risk score to predict significant RAS. Methods: Four thousand one hundred seventy-seven patients who underwent renal angiography between 2002 and 2016 at Tehran Heart Center were included. Significant RAS was defined as narrowing of the renal artery by at least 70%. Multiple predictors of the RAS were determined using multivariable logistic regression with a backward elimination method. The scoring system obtained from the final model was presented as nomogram. The possible nonlinear effect of continuous variables was evaluated using restricted cubic splines. Overfitting of the final model was assessed applying the tenfold cross-validation method. Model performance was checked using calibration plot as well as Hosmer-Lemeshow goodness of fit test, and area under the receiver operating characteristics (ROC) curve. Results: The prevalence of RAS was 14.1%. Female sex (OR [95% CI]: 1.53 [1.26–1.85]), hypertension (OR [95% CI]: 1.38 [1.08–1.77]), estimated glomerular filtration rate (OR [95% CI]: 0.98 [0.97–0.98]), body mass index (OR [95% CI]: 0.97 [0.95–0.99]), and age (OR [95% CI]: 1.01 [1.00–1.02]) were determined as the multiple predictors of RAS. The area under the ROC curve of the final predictive model was 0.702 (95% CI: 0.679–0.725). Conclusion: This model assesses the risk of RAS using available information. This model can be used for both clinical and research purposes.

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Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Cited by 34 publications

References 29 publications

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

Extrarenal atherosclerotic disease blunts renal recovery in patients with renovascular hypertension

Development of a Simple Risk Score Model to Predict Renal Artery Stenosis

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