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

Abstract

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.

Difference between renal and splenic resistive index as a novel criterion in Doppler evaluation of renal artery stenosis

“…Evaluation using the difference of the renal RIs between the left and right kidneys is hampered in the case of a single kidney where the contralateral kidney is not available for comparison, and (in particular) in bilateral RAS where RAS might be not considered, since examiners are focused on a RI‐difference between the 2 kidneys. Several angiographic studies suggest that RAS occurs bilaterally in about 20%‐25% of the cases . In an examination on pediatric patients, bilateral RAS has been observed even in 47% .…”

“…Several angiographic studies suggest that RAS occurs bilaterally in about 20%-25% of the cases. 25,[27][28][29] In an examination on pediatric patients, bilateral RAS has been observed even in 47%. 30 In this study, we found bilateral RAS in 25%, which is well in the range reported by others.…”

The metabolic syndrome and chronic kidney disease

“…[9] Moreover, MetS may impose vascular remodeling and accelerate development of atherosclerotic lesions. Renal artery stenosis, detected in 16% patients with cardiovascular events,[31] further decreases blood supply to the kidney and exacerbates renal damage. Indeed, in post-stenotic swine kidneys, MetS precipitates or magnifies loss of microvessels,[15] thereby aggravating tissue injury.…”

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

“…In a previous study, we also found that the unilateral and bilateral RAS rates were 17 and 6.2% respectively [50]. Some authors suggested that coronary and renal artery angiography should be performed simultaneously in patients with myocardial infarction [54].…”