Survival after stenting of severe atherosclerotic ostial renal artery stenoses.
OBJECTIVE
To examine long-term survival after angioplasty and stenting of atherosclerotic renal artery stenosis (RAS).


METHODS
Over a 5-year period, 241 consecutive patients (153 men; mean age 67+/-9 years, range 44-84) were treated with angioplasty and stent implantation for 355 ostial renal stenoses >70%. The procedures were performed in standard fashion using a variety of stents. For survival analysis, the patients were divided into 3 groups based on baseline creatinine levels: group 1: 115 (48%) patients with normal renal function (creatinine <1.2 mg/dL); group 2: 93 (39%) patients with moderately impaired renal function (creatinine 1.2 to 2.5 mg/dL); and group 3: 33 (13%) patients with severely impaired renal function (creatinine >2.5 mg/dL).


RESULTS
All patients were treated successfully without any procedure-related mortality. The 30-day mortality was 0.4% (1/241). Twenty-two patients died during a follow-up of 27+/-15 months (range 1-60) (overall survival 91%). The causes of death were cardiac (congestive heart failure or myocardial infarction, 73%), stroke (13.5%), and malignant disease (13.5%). The survival rate was significantly lower (29.6%) in patients with a baseline serum creatinine >2.5 mg/dL (p<0.0001) than in groups 2 (89.1%) or 1 (95.4%). Long-term survival without hemodialysis or restenosis was 66.6% at 48 months. Independent predictors for a reduced survival were left ventricle function (HR 2.59, 95% CI 1.45 to 4.63, p=0.001 for each 15% incremental decrease), age (HR 1.13, 95% CI 1.03 to 1.25, p=0.011), and baseline renal function (HR 1.58, 95% CI 1.10 to 2.29, p=0.014).


CONCLUSIONS
Survival after successful stenting for severe ostial RAS depends on baseline serum creatinine and left ventricle function. Efforts must be made to avoid the development of advanced ischemic nephropathy and congestive heart failure.
Zeller
Thomas
T
Department of Angiology, Heart-Center Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Müller
Christian
C
Frank
Ulrich
U
Bürgelin
Karlheinz
K
Schwarzwälder
Uwe
U
Horn
Barbara
B
Roskamm
Helmut
H
Neumann
Franz-Josef
FJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate