Is the routine screening for significant atherosclerotic renal artery stenosis during coronary angiography/intervention indispensable?

Is the routine screening for significant atherosclerotic renal artery stenosis during coronary angiography/intervention indispensable? 1 2 first-author †E-mail:sdrbabic@sezampro.rssdrbabic@gmail.com †E-mail:sdrbabic@sezampro.rssdrbabic@gmail.com sdrbabic@sezampro.rs 1 2 1 2 Institute for Cardiovascular Disease “Dedinje”, Belgrade, Serbia Institute for Cardiovascular Disease “Dedinje”, Belgrade, Serbia School of Medicine, University of Belgrade, Belgrade, Serbia School of Medicine, University of Belgrade, Belgrade, Serbia 1 We read the article “Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention” by Pu et al. ( 2012 2012 ), published in Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) , with great interest. Of particular interest to us was the part considering the logistic regression model in this specific cohort of patients for future screening for significant atherosclerotic renal artery stenosis (ARAS). Although arteriography represents the gold standard for evaluation of ARAS, this exam is invasive and requires nephrotoxic iodinated contrast media which makes it less suitable as a first option for diagnosis or screening. Several non-invasive assessment tools, such as Doppler ultrasound and non-enhanced magnetic resonance angiography, have high sensitivity and specificity rates, but also have certain shortcomings. It seems that the invasive approach presented is too aggressive, considering the results of the regression analysis in this paper (Pu et al., 2012 2012 ); clearly, patients with these variables can be suspected of having significant ARAS. Also, the study design indicates that the primary indication for angiography was coronary artery disease, and that renal angiography was also performed after the completion of coronarography. The results from Table 1 of Pu et al. ( 2012 2012 ) seem puzzling as more than half of the patients ( n =805, 54.2%) had normal coronary angiograms. Although several authors (Alpert, 1994 1994 ; da Costa et al., 2001 2001 ; Bugiardini and Bairey Merz, 2005 2005 ) have described a small series of myocardial infarctions occurring in patients with normal coronary arteries, the incidence of such events is considered to be low, varying from 1% to 12%. Based on this finding, our question is: what was the indication for coronarography in these patients, or how did the authors define the term “normal” in relation to coronary arteries? References JS Alpert . Myocardial infarction with angiographically normal coronary arteries . Arch Intern Med , 1994 . 154 ( 3 ): 265 - 269 . . Myocardial infarction with angiographically normal coronary arteries R Bugiardini , CN Bairey Merz . Angina with “normal” coronary arteries: a changing philosophy . JAMA , 2005 . 293 ( 4 ): 477 - 484 . 15671433 DOI: 10.1001/jama.293.4.477 http://doi.org/10.1001/jama.293.4.477 . Angina with “normal” coronary arteries: a changing philosophy A da Costa , K Isaaz , E Faure , S Mourot , A Cerisier , M Lamaud . Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram: a 3-year follow-up study of 91 patients . Eur Heart J , 2001 . 22 ( 16 ): 1459 - 1465 . 11482919 DOI: 10.1053/euhj.2000.2553 http://doi.org/10.1053/euhj.2000.2553 . Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram: a 3-year follow-up study of 91 patients LJ Pu , Y Shen , RY Zhang , Q Zhang , L Lu , FH Ding , J Hu , ZK Yang , WF Shen . Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention . J Zhejiang Univ-Sci B (Biomed & Biotechnol) , 2012 . 13 ( 8 ): 631 - 637 . 22843183 DOI: 10.1631/jzus.B1201003 http://doi.org/10.1631/jzus.B1201003 . Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention 10.1631/jzus.B1200240 2022-01-05 Copyright © Zhejiang University and Springer-Verlag Berlin Heidelberg 2013 2013 Journal of Zhejiang University-SCIENCE B (Biomedicine and Biotechnology) 01 14