Similar articles

Abstract: Objective: Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods: Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results: Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1−P)=exp(−2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions: The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.

[1]Brueck, M., Bandorski, D., Krame, W., Wieczorek, M., Höltgen, R., Tillmanns, H., 2009. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc. Interv., 2(11):1047-1054.

[2]Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., White, A., Cushman, W.C., White, W., Sica, D., et al., 2008. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation, 117(25):e510-e526.

[3]Cockcroft, D.W., Gault, H.M., 1976. Prediction of creatinine clearance from serum creatinine. Nephron, 16(1):31-41.

[4]Dubel, G.J., Murphy, T.P., 2008. The role of percutaneous revascularization for renal artery stenosis. Vasc. Med., 13(2):141-156.

[5]Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26 (Suppl. 1):S5-S20.

[6]Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001. Executive summary of the third report of National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment Panel III). JAMA, 285(19):2486-2497.

[7]Ghaffari, S., Sohrabi, B., Siahdasht, R.B., Pourafkari, L., 2009. Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography. Hypertens. Res., 32(11):1009-1014.

[8]Guimarães, J., Bastos, M., Melo, M., Carvalheiro, M., 2007. Diabetic nephropathy: glomerular filtration rate and estimated creatinine clearance. Acta Med. Port., 20(2):145-150.

[9]Hackam, D.G., Spence, J.D., Garg, A.X., Textor, S.C., 2007. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension, 50(6):998-1003.

[10]Hirsch, A.T., Haskal, Z.J., Hertzer, N.R., Bakal, C.W., Creager, M.A., Halperin, J.L., Hiratzka, L.F., Murphy, W.R., Olin, J.W., Puschett, J.B., et al., 2006. ACC/AHA 2005 Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Transatlantic Inter-Society Consensus; and Vascular Disease Foundation. J. Am. Coll. Cardiol., 47(6):1239-1312.

[11]Jokhi, P.P., Ramanathan, K., Walsh, S., Fung, A.Y., Saw, J., Fox, R.S., Zalunardo, N., Buller, C.E., 2009. Experience of stenting for atherosclerotic renal artery stenosis in a cardiac catheterization laboratory: technical considerations and complications. Can. J. Cardiol., 25(8):e273-e278.

[12]Lassiter, F.D., 1998. The string-of-beads sign. Radiology, 206(2):437-438.

[13]Li, P., Gai, L.Y., Yang, X., Sun, Z.J., Jin, Q.H., 2010. Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion. J. Zhejiang Univ. Sci. B., 11(8):568-574.

[14]Lu, L., Jin, P.L., Chen, Q.J., Wang, L., Peng, W., Yan, X., Zhang, Q., Yan, Z.R., Gong, P.H., Qiu, J.P., et al., 2008. Increased glycated albumin and decreased esRAGE concentrations are associated with in-stent restenosis in Chinese diabetic patients. Clin. Chim. Acta, 396(1-2):33-37.

[15]Paraskevas, K.I., Hamilton, G., Cross, J.M., Mikhailidis, D.P., 2008. Atherosclerotic renal artery stenosis: association with emerging vascular risk factors. Nephron Clin. Pract., 108(1):c56-c66.

[16]Rao, S.V., Cohen, M.G., Kandzari, D.E., Bertrand, O.F., Gilchrist, I.C., 2010. The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions. J. Am. Coll. Cardiol., 55(20):2187-2195.

[17]Rundback, J.H., Sacks, D., Kent, K.C., Cooper, C., Jones, D., Murphy, T., Rosenfield, K., White, C., Bettmann, M., Cortell, S., et al., 2002. Guidelines for the reporting of renal artery revascularization in clinical trials. Circulation, 106(12):1572-1585.

[18]Safian, R.D., Textor, S.C., 2001. Renal-artery stenosis. N. Engl. J. Med., 344(6):431-442.

[19]Sapoval, M., Tamari, I., Goffette, P., Downes, M., Senechal, Q., Fanelli, F., Reimer, P., Negaiwi, Z., de Cassin, P., Heye, S., et al., 2010. One year clinical outcomes of renal artery stenting: the results of ODORI Registry. Cardiovasc. Intervent. Radiol., 33(3):475-483.

[20]Shiraishi, J., Higaki, Y., Oguni, A., Inoue, M., Tatsumi, T., Azuma, A., Matsubara, H., 2005. Transradial renal artery angioplasty and stenting in a patient with Leriche syndrome. Int. Heart J., 46(3):557-562.

[21]Slovut, D.P., 2009. Screening renal angiography as a routine part of cardiac catheterization: a reappraisal. Vasc. Med., 14(3):271-275.

[22]Solomon, R., Dauerman, H.L., 2010. Contrast-induced acute kidney injury. Circulation, 122(23):2451-2455.

[23]van Helvoort-Postulart, D., Dirksen, C.D., Nelemans, P.J., Kroon, A.A., Kessels, A.G., de Leeuw, P.W., Vasbinder, G.B., van Engelshoven, J.M., Hunink, M.G., 2007. Renal artery stenosis: cost-effectiveness of diagnosis and treatment. Radiology, 244(2):505-513.

[24]van Jaarsveld, B.C., Krijnen, P., Pieterman, H., Derkx, F.H., Deinum, J., Postma, C.T., Dees, A., Woittiez, A.J., Bartelink, A.K., Man in′t Veld, A.J., et al., 2000. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. N. Engl. J. Med., 342(14):1007-1014.

[25]Weber-Mzell, D., Kotanko, P., Schumacher, M., Klein, W., Skrabal, F., 2002. Coronary anatomy predicts presence or absence of renal artery stenosis: a prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease. Eur. Heart J., 23(21):1684-1691.

[26]Wheatley, K., Ives, N., Gray, R., Kalra, P.A., Moss, J.G., Baigent, C., Carr, S., Chalmers, N., Eadington, D., Hamilton, G., et al., 2009. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med., 361(20):1953-1962.

[27]White, C.J., Olin, J.W., 2009. Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes. Nat. Clin. Pract. Cardiovasc Med., 6(3):176-190.

[28]Yan, H.B., Zheng, B., Wu, Z., Wang, J., Zhao, H.J., Song, L., Chi, Y.P., 2010. Two-stent strategy for renal artery stenosis with bifurcation lesion. J. Zhejiang Univ. Sci. B., 11(8):561-567.

[29]Yip, H.K., Chung, S.Y., Chai, H.T., Youssef, A.A., Bhasin, A., Yang, C.H., Chen, S.M., Hang, C.L., Hsieh, Y.K., Chen, C.J., et al., 2009. Safety and efficacy of transradial vs. transfemoral arterial primary coronary angioplasty for acute myocardial infarction: single-center experience. Circ. J., 73(11):2050-2055.

[30]Zhang, R.Y., Zhu, Z.B., Zhang, Q., Yang, Z.K., Hu, J., Lv, A.K., Zhang, J.S., Shen, W.F., 2009. Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-eluting stent based coronary intervention. Int. J. Cardiol., 136(1):72-79.