Inflammation and adverse cardiovascular outcome in patients with renal artery stenosis and peripheral artery disease

Abstract 

Objectives

We hypothesized that high sensitivity C-reactive protein (hs-CRP) and the presence of renal artery stenosis (RAS) might conjointly predict future major adverse cardiovascular events (MACE) in patients with peripheral artery disease (PAD).

Background

Clinical outcome in PAD is determined by the extent of atherosclerosis affecting additional vascular beds and the activity of the atherosclerotic process reflected by inflammatory serum markers. Data on the predictive value of hs-CRP on outcome in PAD patients with RAS is limited.

Methods

We prospectively enrolled 447 PAD patients who were admitted to our institution for angioplasty. Preintervention hs-CRP was assessed and renal angiograms were obtained. Patients were then followed clinically for the occurrence of MACE for median 15.6 months. Serum creatinine was obtained in all patients at 12 months.

Results

Incidental RAS ≥60% at baseline was found in 68 patients (15.2%), MACE were recorded in 111 patients during follow-up. Hs-CRP was significantly associated with the occurrence of MACE (p<0.001) and with 12 months creatinine levels (p=0.005). Adjusted hazard ratios for MACE for increasing quartiles of hs-CRP as compared to the lowest quartile were 1.11 (95% CI 0.53–2.35), 1.06 (95% CI 0.50–2.26) and 2.79 (95% CI 1.47–5.28). Analyzing joint effects of hs-CRP and RAS, we observed no significant interaction.

Conclusion

Hs-CRP predicts cardiovascular and renal outcome in PAD patients irrespective of the presence of RAS. Patients with hs-CRP levels above 0.88mg/dL were at particularly high risk for MACE.

Keywords: Peripheral vascular disease, Atherosclerosis, Renal, Outcome