Bypass of Coronary Artery in Renal Artery Stenosis Patients with Heart Chronic Total Occlusion Might Explain the 5-Year Follow-Up after Percutaneous Coronary Intervention: B-RASHEF Study.

Introduction: Renal artery stenosis (RAS) is associated with poor outcome in patients with ischemic heart disease. In this study, we investigated the development of coronary collateral in RAS patients and possible association of RAS with a 5-year outcome after chronic total occlusion-percutaneous coronary intervention (CTO PCI).

Methods: Consecutive 58 patients with CTO PCI were enrolled prospectively, including 21 RAS patients (15 unilateral RAS and 6 bilateral RAS) and 37 non-RAS patients. RAS was diagnosed by renal duplex. Coronary collaterals were appraised by CC classification and Rentrop classification.

Results: Development of left anterior descending artery coronary collateral by Rentrop classification was significantly worse in RAS patients than non-RAS patients. Kaplan-Meier curve of survival was significantly worse in RAS patients than non-RAS patients (p = 0.027). By univariate COX proportional hazard regression analysis, collateral development by CC classification was a significant predictor for 5-year survival. When age, RAS, and collateral development by CC classification were included in multivariate COX proportional hazard regression analysis, only age (hazard ratio: 1.349; 95% confidential interval: 1.058-1.720; p = 0.016) and RAS (hazard ratio: 6.680; 95% confidential interval: 1.322-33.747; p = 0.022) were significant predictors for 5-year survival.

Discussion/conclusion: We concluded that survival in RAS patients after CTO PCI is significantly worse than non-RAS patients, and RAS is a significant predictor for survival after CTO PCI. It seems that injured collateral development might partly explain increased all cause death in RAS patients.