Frequency of Coronary Artery Disease in Patients With Renal Artery Stenosis Without Clinical Manifestations of Coronary Insufficiency

Carvalho, Fabyola Barros de; Bregagnollo, Edson Antônio; Silva, Vanessa Santos; Brunie, Andréa; Franco, Roberto Jorge da Silva; Martin, Luís Cuadrado; Gavras, Irène; Gavras, Haralambos

doi:10.1016/j.amjhyper.2006.04.011

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…1 Ischemic nephropathy progresses to end-stage renal disease (ESRD) in 6-17% of patients. [2][3][4] RAS is the most common potentially reversible disorder leading to renal replacement therapy. 5,6 Moreover, the presence of RAS has been independently associated with increased mortality, particularly in patients with coronary artery disease (CAD) and ESRD.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…However, evidence in this important research area is scanty. To the best of our knowledge, there is one single study also from Brazil involving a small number of patients (n = 23) reporting a high prevalence of CAD (74%) in patients with significant RAS [17]. It should be stressed that this preliminary investigation did not systematically evaluate patients at risk of RAS, and the definition of CAD also included patients with less severe coronary stenosis (>50%).…”

Section: Discussionmentioning

confidence: 97%

Renal Artery Stenosis Predicts Coronary Artery Disease in Patients with Hypertension

et al. 2013

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In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction≥70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63±12 vs. 56±13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS≥70% was independently associated with CAD≥70% (OR: 11.48; 95% CI 3.2–40.2; p<0.001), even in patients without angina (OR: 13.48; 95%CI 2.6–12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS≥70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.

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“…However, this finding was expected considering the high prevalence of RAS in hypertensive patients undergoing angiographic procedures for CAD. De Carvalho found that 74% of patients with RAS had concurrent CAD in one or more coronary arteries, although they had no symptoms of coronary insufficiency [6]. In addition, Ollivier et al reported that among 650 patients suffering from CAD, 94 presented with RAS, corresponding to an estimated prevalence of 14.5%, including 6% of patients with left coronary artery stenosis, 5.4% with right coronary artery stenosis, and 3.1% with bilateral stenosis [26].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that coronary artery disease (CAD) is one of the most important causes of death in patients with atherosclerotic RAS. In addition, a high prevalence of RAS has been reported in patients with documented CAD [6][7]. Contrast angiography is a standard method for the detection of RAS that is readily performed in combination with coronary angiography [8].…”

Section: Introductionmentioning

confidence: 99%

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

et al. 2011

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BackgroundRenal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known.ObjectivesThis study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography.Patients and MethodsIn a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model.ResultsThe mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors.ConclusionsThis study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD.

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Frequency of Coronary Artery Disease in Patients With Renal Artery Stenosis Without Clinical Manifestations of Coronary Insufficiency

Cited by 8 publications

References 20 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

Renal Artery Stenosis Predicts Coronary Artery Disease in Patients with Hypertension

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

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