Purpose

Coronary angiography in asymptomatic patients with End Stage Renal Disease (ESRD) shows significant Coronary Artery Disease (CAD) (stenosis >50%) in 37-53% of patients. We have previously shown that older, male patients with history of diabetes were more likely to have obstructive CAD in their pre-transplantation (Tx) assessment. Our aim was to create a model that could predict the likelihood of CAD in these patients and help with clinical decision for investigations before Tx.

Methods

We included all asymptomatic patients who were evaluated between 2002-2013. Patients were excluded if they had history of ischemic heart disease, cardiac symptoms or electrocardiographic findings suggestive of ischemia.

Results

1083 patients (36.9% male) were included in the study and underwent coronary angiography. Median age was 56 years (range 19-79 years). 42.7% of patients were Caucasians, 39.7% were South Asians and 13.5% Afro-Caribbeans. 65.5% of the patients were on dialysis, 33.5% were pre-emptive and 4% had failing renal transplants. 46.8% were diabetics, 70.9% had hyperlipidemia and 36.9% smoked. 36.2% were diagnosed with obstructive CAD and 17.3% required treatment.

Multivariate analysis showed that older patients (p=0.001), Afro-Caribbeans (p=0.006), diabetics (p<0.001), patients with hypertension(HTN) (p=0.002), hyperlipidemia (p=0.001) and smokers (p=0.002) were more likely to have significant CAD.

A simplified logistic regression model was developed to predict obstructive CAD. Age (OR 1.02, 1.01-1.04, p=0.002), diabetes (OR 2.83, 2.01-3.99, p<0.001), hyperlipidemia (OR 1.94, 1.29-2.90, p=0.001), HTN (OR 4.95, 1.89-12.97, p=0.001), and smoking (OR 1.83, 1.29-2.59, p=0.001) could predict the presence of CAD with area under ROC curve 0.7246 (0.6858, 0.7632).

Similarly, Afro-Caribbean race (OR 0.32, 0.14-0.72, p=0.006), diabetes (OR 2.62, 1.72-4, p<0.001), hyperlipidemia (OR 3.29, 1.77-6.11, p<0.001) and HTN (OR 9.49, 1.27-70.54, p=0.028) could predict the need for intervention with an area under ROC curve 0.7476 (0.7032, 0.7919).

Conclusions

In this large study, one third of asymptomatic patients with ESRD had obstructive CAD. The risk score derived from this model can be used for prediction of presence of CAD and of need for intervention in this population. This could guide the clinical decision regarding the need for invasive pre-Tx assessment.

CITATION INFORMATION: Moutzouris D, Baker C, Willicombe M, Duncan N, Galliford J, McLean A, Taube D. Predicting Obstructive Coronary Artery Disease in Asymptomatic Patients Undergoing Renal Transplantation Using a Simple Risk Score. Am J Transplant. 2016;16 (suppl 3).

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