Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease.

Abstract

This study aimed to determine the prevalence of renal artery stenosis (RAS) and associated risk factors in patients undergoing cardiac catheterization for suspected coronary artery disease (CAD). One hundred and seventy-seven consecutive patients (62 females) with a serum creatinine concentration <2.0mg.dl(-1) were studied. Abdominal aortography followed cardiac catheterization to screen for RAS. In 110 patients (62%) CAD and in 19 patients (11%) significant RAS (luminal narrowing of >or=50%) were detected, 12 of whom had high grade (>or=70%) RAS, and two subjects had significant RAS without CAD. Patients with RAS were older (67+/-8 vs 61+/-11 years, mean+/-SD;P =0.004), had higher systolic blood pressure (150+/-15 vs 138+/-20 mmHg;P =0.005), a lower glomerular filtration rate (GFR; 61+/-16 vs 80+/-22 ml.min(-1), P<0.001) and more often diabetes mellitus (69% vs 30%; P=0.004). In multivariate analysis a low GFR and the extent of CAD were independent predictors of RAS. The presence of >2 significant coronary lesions predicted RAS (sensitivity 0.84, specificity 0.77, positive predictive value 0.30, negative predictive value 0.98). Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.