Renal artery stenosis in patients with coronary artery disease

Renal dysfunction is an important factor of cardiovascular risk. Renal artery stenosis (RAS) is a potential cause of secondary hypertension and by renal ischemia may lead to progressive renal insuficiency. In RAS patients a significant increase in prevalence of coronary artery disease (CAD) as well as revascularisation rate and mortality rate was observed.

To determine the prevalence of RAS in patients with suspected CAD.

The study group consisted of 1036 consecutive patients (700 men; 67.6% ) in the mean age of 62.1+/-9.7 (25-85) years admitted to coronary angiography. Simultaneously renal angiography was performed in all patients.

Stenosis > or = 50% in at least one main branch of coronary artery was found in 633 (66.1%) patients. The proportion of patients with one, two or three vessel CAD was respectively 291 (46%), 169 (26%) and 173 (27.3%). Non-significant coronary lesions <50% were found in 108 (10.4%) patients, whereas in 295 (28.5%) patients no angiographic evidence of CAD was documented. In the whole group of patients RAS was found in 339 (32.7%) of patients - 124 (12%) had bilateral lesions. RAS prevalence in patients with CAD was 38.3% (284/741) and its frequency increased with severity of CAD: from 25% (27/108) in patients with insignificant coronary lesions up to 36.4% (106/291), 40.2% (68/169) and 48% (83/173) in 1, 2, and 3-vessel disease, respectively (p <0.001). RAS prevalence in patients with normal coronary arteries was 18.6% (55/295). RAS <30% was detected in 194 (18,7%) patients; RAS between 30-49% in 81 patients (8.7%); RAS 50-69% in 38 patients (3.7%) and RAS > or = 70% in the remaining 26 patients (2.5%). RAS > or = 50% was noted in 8 (2.7%) patients without coronary lesions; in 5 (4.6%) with insignificant coronary artery atherosclerosis and 51 (8%) with coronary artery stenosis >50% (p=0.0008). Stepwise regression analysis identified 4 independent predictors of RAS > or = 50%: CAD severity (p=0.014), serum creatinine concentration (p <0.001), cigarette smoking (p=0.02) and stenosis of aortic arch branches (p <0.001).

RAS is a frequent finding in patients with suspected CAD. CAD severity, number of involved aortic arch arteries, cigarette smoking and serum creatinine are independent RAS predictors.