Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis (RAS) is a strong independent predictor of mortality in patients with coronary artery disease (CAD). The study aimed to determine the prevalence of RAS in patients with significant CAD in order to develop and validate a score predicting RAS. Three hundred consecutive patients (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of 50% or more. Univariate and multivariate analyses were performed comparing patients with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS. The score was internally validated in patients randomly selected from the entire study group (validation group; n = 103), using ROC curves and the Hosmer–Lemeshow goodness-of-fit test. Twenty-seven patients (9%) had a significant RAS. Multivariate analysis showed that age over 65 years (OR = 4.1%, 95% CI = 1.6-10.3, p = 0.003) and hypertension (OR = 3.1, 95% CI = 1.2–7.7, p = 0.015) were independent predictors of RAS. The predictive score including these two variables and three others (female gender, renal and insufficiency, and more than 2- or 3-vessel disease) ranged from 0 to 7. Internal validation showed a good performance (ROC curve = 0.79 and χ2 Lemeshow = 3.45). For a score of less than 2, the negative predictive value is 98%. The rate of significant RAS in patients with significant CAD was 9%. The performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score.