title: Prevalence of renal artery disease and its prognostic significance in patients undergoing coronary bypass grafting.
abstract: Several studies demonstrated the prognostic importance of renal failure and peripheral artery disease in patients undergoing coronary artery bypass grafting (CABG), but data regarding the prognostic value of renal artery disease in this context are scarce. We aimed to study the prevalence and prognostic value of renal artery disease in patients undergoing CABG. We assessed by duplex ultrasound the renal arteries of 429 consecutive patients who underwent CABG, of whom 401 had satisfactory imaging quality to detect >60% renal artery stenosis (RAS) and/or an elevated resistive index (ERI>0.80). Of the 401 subjects included (age 68±10 years, 83% men), 40 (10%) had RAS and 35 (9%) had ERI. Nine patients (2.2%) had both conditions. Patients were followed up for 12.4±7.0 months. The primary outcome was composite, including 30-day death, stroke, and/or myocardial infarction. In a multivariate model adjusted for age, gender, cardiovascular (CV) risk factors, renal function, chronic obstructive pulmonary disease, the use of off-pump CABG, CV co-morbidities, and drugs, the presence of ERI was strongly associated with the occurrence of the composite outcome (odds ratio 4.3, 95% confidence interval 1.7 to 9.9, p=0.0006). Similarly, ERI, not RAS, was significantly associated with the 30-day acute kidney disease and the midterm mortality, as well as fatal and nonfatal CV events. In conclusion, regardless of renal function and other factors, the renal resistive index is a strong predictor of CV and renal events after CABG. Renal duplex ultrasound can identify a subgroup of patients at high risk of CABG.
authors.affiliation: Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm U1094, School of Medicine, University of Limoges, Limoges, France. Electronic address: victor.aboyans@unilim.fr.
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
authors.affiliation: Department of Cardiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Tanguy
authors.affiliation: Inserm U1094, School of Medicine, University of Limoges, Limoges, France; Department of Thoracic & Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Ileana
authors.initials: I
authors.lastname: Desormais
authors.affiliation: Department of Cardiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bonnet
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Denver, Colorado.
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.affiliation: Department of Thoracic & Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm U1094, School of Medicine, University of Limoges, Limoges, France.
authors.forename: Dania
authors.initials: D
authors.lastname: Mohty
authors.affiliation: Inserm U1094, School of Medicine, University of Limoges, Limoges, France; Department of Thoracic & Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lacroix
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance / Q000502:physiology*