Prevalence and risk Factors of renal artery stenosis in patients und undergoing coronary angiography / 대한내과학회지

ABSTRACT

OBJECTIVES: The distributive pattern of atherosclerotic vascular disease is known to be different among the races. In Caucasian population, renal artery stenosis (RAS) was reported to be a frequent finding in the patients with ischemic heart disease (IHD), ranging from 5% to 29%. We investigated the prevalence of RAS and the risk factors in Korean patients. METHODS: Over a 12-month period, 574 patients (MF, 407167) with clinical IHD underwent cardiac catheteriza tion. Before the procedure, demographic data, medical history, physical findings, and blood chemistries were ob tained. During the procedure, selective renal arteriogram was also obtained. The degree of renal artery stenosis was quantitated with automatic edge detection technique, and narrowing of diameter greater than 50% was considered to be significant. RESULTS: RAS was identified in 42 patients (7%), of whom 5 patients (1%) had bilateral disease. Angiographi cally significant coronary artery disease was present in 473 patients. The prevalence of RAS in patients with single, double and triple vessel disease of coronary artery were 4% (9/235), 13% (20/154), and 12% (10/84), respec tively. Among the 101 patients with normal coronary arteries, 3 (3%) had RAS. By univariate analysis, there was significant difference between RAS and non-RAS in age (66+/-8 yrs vs 59+/-10 yrs, p<0.0001), duration of hypertension (7.3+/-1.3 yrs vs 3.40.3 yrs, p=0.0002), and the frequency of double or triple +/-coronary artery disease (p=0.004). However, no association was found between RAS and serum lipids, lipoprotein(a), creatinine, sex, smoking, diabetes mellitus, or peripheral vascular disease. By multivariate logistic regression analysis, the following parameters were independent risk factors for RAS age over 65 years (p<0.001), duration of hypertension (p=0.003), and coronary artery disease involving double or triple vessels (p=0.004). CONCLUSION: The prevalence of RAS in Koreans is somewhat lower than in western population. However, in patients with high degree coronary heart disease, old age over 65 years, or long history of hypertension, the possibility of combined RAS should be considered.