Introduction Renal artery stenosis (RAS) is one aspect of a multiterritory atherosclerotic disease. This study was to evaluate the incidence of RAS in the patients with CHD treating with various therapeutic regimen.
Method From July 2008 to March 2010, intra-renal arterial digital subtraction angiography was performed in 302 patients who underwent coronary angiography. The incidence of ≥50% unilateral or bilateral renal artery stenosis were investigated in the population of the patients without and with CHD treating with various therapeutic regimens as following. By evaluating the coronary angiogram, the patients were not diagnosed to have CHD with less than 50% diameter stenosis of coronary artery; CHD was defined as narrowing of the appropriate lumen of ≥50%; the procedure of PCI were performed in the patients with more than or equal to 70% stenosis; the CABG had been proposed in patients with left main coronary artery lesions, left main equivalent, diffuse triple coronary artery lesions, two-vessel disease with significant proximal left anterior descending CAD. the intra-renal arterial digital subtraction angiography was performed, the renal artery stenosis was evaluated by three interventional cardiologists. RAS was defined as narrowing of the appropriate lumen of ≥50%.
Results In 302 patients, 47 patients (15.56%) had not been diagnosed to have CHD; 255 (84.44%) to have CHD, of these patients with CHD, 80 patients (26.49%) were not indicated for PCI, 24 (7.95%) had been performed the procedure of stent implantation, 151(50%) proposed to have CABG. The incidence rates of renal artery stenosis were 6.38% (3/47) in patients without CHD and 40% (102/302) in patients with CHD (p=0.00087). In the four various therapeutic regimen groups, the incidence rates of RAS were 6.38% (3/47) in the patients without CHD, 35% (28/80) in the patients who were not indicated for PCI, 12.5% (3/24) in the patients performed stent implantation, and 47.02% (71/151) in the patients proposed to CABG. the incidence of RAS of the patients performed stent implantation was significantly lower than the patients who were not indicated for PCI (p=0.035) and the patients proposed to CABG (p=0.001). The age of was significantly older in patients with RAS than without RAS (p<0.0005). The morbidity rate of Diabetes (37.14% and 25.38%, p=0.033), Cerebral infarction (24.76% and 9.65%, p<0.0005) and CHD (97.14% and 77.67%, p<0.0005) were significantly higher in patients with RAS than without RAS. There is trend that more patients with Grade 3 hypertension in RAS group than normal renal artery group (65.71% vs 55.84%, p=0.096). There were more patients with very high risk factors for cardiovascular diseases in RAS group than normal renal artery group (90.48% vs 78.68%, p=0.01).
Conclusion The incidence of RAS was 6.38%% in patients without CHD and 40% in patients with CHD. The incidence of RAS of the patients who were not indicated for PCI or proposed to CABG was higher than the patients performed stent implantation and patients without CHD. the age, Diabetes, Cerebral infarction, CHD, Grade 3 hypertension, and very high risk factors for cardiovascular diseases are the risk factors for RAS.