Relationship between Distribution of Coronary Artery Lesions and Renal Artery Stenosis in Patients Undergoing Simultaneous Coronary and Renal Angiography

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Abstract

Aims:

We evaluated the relationship between distribution of lesions in coronary tree and atherosclerotic renal artery stenosis (RAS).

Methods and results:

Data collected prospectively on 500 consecutive patients who underwent simultaneous renal angiography following coronary angiography. Overall prevalence of RAS was 26.2% (131 patients). Significant (≥50% luminal diameter stenosis) RAS was present in 70 patients (14%). In 346 individuals of the study population, significant CAD was present (69.2%). Significant RAS was more common (18.4%) in this group. Older age, higher intra-arterial systolic blood pressure (SBP) and pulse pressure (PP) at the time of catheterization, and 3-vessel coronary artery disease (CAD) were associated with significant RAS in univariate analysis. Relationship between involved locations of coronary arteries [Left anterior descending (LAD), left circumflex (LCX), Right Coronary Artery (RCA), and their ostio-proximal portions] and RAS were significant except for left main (LM) disease. In multivariate model, age more than 62 years, SBP greater than 150 mmHg, PP in excess of 60 mmHg and RCA involvement were independent predictors of significant RAS.

Conclusion:

Simultaneous renal angiography following coronary angiography might be justified in patients with significant RCA disease who are older with increased levels of intra-arterial SBP and PP.

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Most cited references 23

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Revascularization versus medical therapy for renal-artery stenosis.

Keith Wheatley, Natalie Ives, Richard Gray … (2009)

Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited. In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance). Secondary outcomes were blood pressure, the time to renal and major cardiovascular events, and mortality. The median follow-up was 34 months. During a 5-year period, the rate of progression of renal impairment (as shown by the slope of the reciprocal of the serum creatinine level) was -0.07x10(-3) liters per micromole per year in the revascularization group, as compared with -0.13x10(-3) liters per micromole per year in the medical-therapy group, a difference favoring revascularization of 0.06x10(-3) liters per micromole per year (95% confidence interval [CI], -0.002 to 0.13; P=0.06). Over the same time, the mean serum creatinine level was 1.6 micromol per liter (95% CI, -8.4 to 5.2 [0.02 mg per deciliter; 95% CI, -0.10 to 0.06]) lower in the revascularization group than in the medical-therapy group. There was no significant between-group difference in systolic blood pressure; the decrease in diastolic blood pressure was smaller in the revascularization group than in the medical-therapy group. The two study groups had similar rates of renal events (hazard ratio in the revascularization group, 0.97; 95% CI, 0.67 to 1.40; P=0.88), major cardiovascular events (hazard ratio, 0.94; 95% CI, 0.75 to 1.19; P=0.61), and death (hazard ratio, 0.90; 95% CI, 0.69 to 1.18; P=0.46). Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs. We found substantial risks but no evidence of a worthwhile clinical benefit from revascularization in patients with atherosclerotic renovascular disease. (Current Controlled Trials number, ISRCTN59586944.) 2009 Massachusetts Medical Society

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Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.

Cornelis T Postma, Ton Rabelink, Paul A. Kroon … (2009)

Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function. Randomized clinical trial. Randomization was centralized and computer generated, and allocation was assigned by e-mail. Patients, providers, and persons who assessed outcomes were not blinded to treatment assignment. 10 European medical centers. 140 patients with creatinine clearance less than 80 mL/min per 1.73 m(2) and ARAS of 50% or greater. Stent placement and medical treatment (64 patients) or medical treatment only (76 patients). Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. The primary end point was a 20% or greater decrease in creatinine clearance. Secondary end points included safety and cardiovascular morbidity and mortality. Forty-six of 64 patients assigned to stent placement had the procedure. Ten of the 64 patients (16%) in the stent placement group and 16 patients (22%) in the medication group reached the primary end point (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]). Serious complications occurred in the stent group, including 2 procedure-related deaths (3%), 1 late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism. The groups did not differ for other secondary end points. Many patients were falsely identified as having renal artery stenosis greater than 50% by noninvasive imaging and did not ultimately require stenting. Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. The study findings favor a conservative approach to patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting.

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Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography.

K Pieper, Kristen M. Little, P Conlon … (2001)

Renal artery stenosis (RAS) is a relatively uncommon but potentially reversible cause of renal failure. In a previous report, we demonstrated that the presence of RAS is independently associated with mortality in a group of patients undergoing coronary angiography. Our current study expands on this cohort, investigating the effect of the severity of RAS on all-cause mortality. A total of 3987 patients underwent abdominal aortography immediately following coronary angiography. For the purpose of survival analysis, significant RAS was defined as > or =75% narrowing in the luminal diameter. Significant RAS was present in 4.8% of patients studied and was bilateral in 0.8%. Factors associated with the presence of RAS included female gender, older age, hypertension, congestive heart failure, elevated serum creatinine, and congestive heart failure. The four-year unadjusted survivals for patients with and without significant RAS were 57 and 89%, respectively (P or =95% stenosis was 70%, 68%, and 48%, respectively. In addition, bilateral disease was associated with four-year survival of 47% as compared with 59% for patients with unilateral disease (P < 0.001). The impact of RAS on survival remained robust regardless of the manner of treatment of coronary artery disease [that is, medical, percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG)]. In this patient population, the presence of RAS is a strong independent predictor of mortality. Increasing severity of RAS has an incremental effect on survival probability.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Med Insights Cardiol

Journal ID (publisher-id): 101466475

Title: Clinical Medicine Insights. Cardiology

Publisher: Libertas Academica

ISSN (Electronic): 1179-5468

Publication date Collection: 2011

Publication date (Electronic): 20 March 2011

Volume: 5

Pages: 35-40

Affiliations

[1 ]Assistant professor, Department of Interventional Cardiology, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran

[2 ]Fellowship of Interventional Cardiology in Shaheed Rajaie Cardiovascular Medical and Research Center, Assistant professor of Mashhad University of Medical Sciences, Mashhad, Iran

[3 ]Cardiologist, Bahan Hospital, Tehran, Iran

[4 ]Medical Student Research Committee, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Author notes

Corresponding author email: farshadshakerian@ 123456gmail.com

Article

Publisher ID: cmc-2011-035

DOI: 10.4137/CMC.S6819

PMC ID: 3072210

PubMed ID: 21487456

SO-VID: 76c634e7-caef-4efe-8607-c6404092dddc

License:

This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

Relationship between Distribution of Coronary Artery Lesions and Renal Artery Stenosis in Patients Undergoing Simultaneous Coronary and Renal Angiography

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Abstract

Aims:

Methods and results:

Conclusion:

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Cardiovascular Innovations and Applications

Most cited references 23

Revascularization versus medical therapy for renal-artery stenosis.

Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.

Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography.

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