Prevalence of renal artery stenosis in patients undergoing cardiac catheterization

Abstract

To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR <67 ml/min/1.73 m(2), age >66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73-0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

Non-Hemodynamically Significant Renal Artery Stenosis Predicts Cardiovascular Events in Persons with Ischemic Heart Disease

“…We evaluated the relationship between renal artery diameters, either RD or MD, RAS and cardiovascular events in 623 subjects with ischemic heart disease of the RAS-CAD cohort [11,12]. We reported that the incidence of cardiovascular events was increased in subjects with low-to-moderate renal artery stenosis and that, in these subjects, those with reduced MD had a significantly increased GFR-independent risk to develop a first cardiovascular event independently.…”

“…The design and selection criteria for the RAS-CAD cohort has been detailed previously [12]. Briefly, prospectively from March 2006 for 1 year, as part of a diagnostic cardiac catheterization study, the RAS-CAD study (NCT 01173666) [11], all consecutive patients affected by ischemic heart disease, referred to the Cardiac Catheterization laboratories of the Division of Cardiology, University of Catania, with a clinical indication for coronary angiography for symptomatic angina or positive findings on a cardiac functional test, underwent coronary and renal arteriography during the same angiographic session.…”

“…Coronary and renal arteriography were performed during the same angiographic session as previously described [12]. The coronary artery disease severity was classified on the basis of the presence of at least two vessels with significant stenoses or a single stenosis on left main (CAD ≥2).…”

“…MD and RD were determined as reported in figure 1. The reproducibility of renal artery diameter measurement was described previously [12]. …”

“…We took advantage of the RAS-CAD cohort [11,12] to demonstrate that the renal artery diameter was a significant predictor of cardiovascular events, independently of principle cardiovascular risk factors and major confounders.…”