1. Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography Arash Gholoobi, M.D. Interventional Cardiologist Preventive Cardiovascular Care Research Center Imam Reza Hospital, School of Medicine Mashhad University of Medical Sciences Mashhad, IRAN

2. Introduction  Atherosclerotic renal artery stenosis (RAS) is an important and often overlooked contributor to renal insufficiency, refractory hypertension and overall cardiovascular mortality  RAS is a potentially treatable condition with surgical or percutaneous revascularisation which is associated with improved clinical outcomes including:  The reduction in the number of antihypertensive medications and improved control of HTN  Preservation of renal function and prevention of hemodialysis with timely intervention  No screening study other than conventional renal angiography can reasonably exclude the presence of RAS

3. Clinical Clues for Renovascular HTN

4. Materials and Methods  In a cross-sectional study of patients who were candidates for evaluation of suspected CAD, a total of 260 were enrolled in two educational hospitals in Mashhad (Emam Reza & Qaem) from April 2005 to 2006  Selection criteria included hypertensive or diabetic subjects, and patients were excluded if serum creatinine level was > 2.5 mg/dl

5. © 2012 EuroIntervention. All rights reserved. EuroInterv.2008;4:373-377 Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

6. © 2012 EuroIntervention. All rights reserved. EuroInterv.2008;4:373-377 Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

7. © 2012 EuroIntervention. All rights reserved. EuroInterv.2008;4:373-377 Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

8. © 2012 EuroIntervention. All rights reserved. EuroInterv.2008;4:373-377 Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

9. © 2012 EuroIntervention. All rights reserved. EuroInterv.2008;4:373-377 Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

10. Discussion  The overall prevalence of RAS in our patients was considerably high  It seems that HTN is both an important risk factor and a manifestation of RAS, and DM alone is not a significant predictor of RAS unless HTN coincides with it  Multivessel CAD is an independent predictor of RAS and normal coronary arteries are a strong negative predictor (negative predictive value=95%)

11. Conclusion  Considering the limitations of non-invasive techniques, it seems reasonable, safe and cost effective to perform renal following coronary angiography in patients with multivessel CAD, especially if the following risk predictors are also present:  HTN alone or accompanied with DM  Elevated intra-arterial systolic and pulse pressures during catheterisation  Advanced age  Female sex  Reduced eGFR

12. ACCF/AHA Guideline  The performance of arteriography to identify significant RAS may be reasonable in patients with multivessel coronary artery disease and none of the clinical clues or PAD at the time of arteriography (Class IIb)