Abstract
In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction≥70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63±12 vs. 56±13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS≥70% was independently associated with CAD≥70% (OR: 11.48; 95% CI 3.2–40.2; p<0.001), even in patients without angina (OR: 13.48; 95%CI 2.6–12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS≥70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.
Highlights
Atherosclerotic renal artery stenosis (RAS) is a well-recognized cause of secondary arterial hypertension and independently associated with cardiovascular events [1,2]
Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS$70% may be a strong predictor of severe coronary artery disease (CAD), independently of angina, and dual investigation should be considered
We hypothesize that the presence of significant RAS could be a useful marker to identify CAD in hypertensive patients referred for renal angiography
Summary
Atherosclerotic renal artery stenosis (RAS) is a well-recognized cause of secondary arterial hypertension and independently associated with cardiovascular events [1,2]. More than a common association, the presence of RAS seems to be equivalent to coronary artery disease in terms of cardiovascular risk [5]. Regarding the increased prevalence of RAS among patients with CAD and the poorer prognosis associated with the presence of RAS the American Heart Association/American College of Cardiology recommends performing renal angiography at the same time as coronary angiography, when the patient with CAD has unexplained renal failure, resistant hypertension or multivessel coronary disease [7]. It is not clear when to perform coronary angiography in hypertensive patients referred for renal angiography with suspicious of RAS. We hypothesize that the presence of significant RAS could be a useful marker to identify CAD in hypertensive patients referred for renal angiography
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