Almost 50% of asymptomatic patients with End Stage Renal Disease (ESRD) are reported to have significant flow-limiting coronary artery disease (CAD). Our practice involves a relatively aggressive approach (coronary angiography) and we have shown that this is associated with excellent survival. However, many patients have an unnecessary coronary angiogram and the purpose of this study is to develop a tool to predict significant CAD (defined as >50% stenosis in one or more vessels) in asymptomatic patients awaiting transplantation.

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 of ischemia.

819 patients (509 males, 310 females) were included. Median age was 56 years (range 24-76). 43.9% of patients were Caucasians, 37% South Asians and 13% Afro-Caribbeans. 61% of the patients were on dialysis, 35.3% were pre-dialysis and 3.7% had failing transplants. 46.9% were diabetics and 36.1% had history of previous transplantation. Patients were on RRT for a median of 6 months (range 0-487). 36.1% had obstructive CAD. 18.4% required treatment (90 patients stent and 52 patients CABG). Male patients (p<0.001), South Asians (p=0.01), older (p=0.001), diabetic patients (p<0.001), smokers (p<0.001) were more likely to have obstructive CAD. There was no difference regarding ESRD modality (p=0.948) or duration (p=0.157).

A logistic regression model was developed to predict obstructive CAD and need for intervention. Female [Odds Ratio (OR) 0.632 95% Confidence Interval (CI) 0.460-0.868, p=0.005)], non-diabetic (OR=0.319, 95% CI 0.233-0.436, p<0.001) and younger patients (<50 years) (OR=0.675, 95% CI 0.480-0.949, p=0.024) were less likely to be diagnosed with obstructive CAD. Similarly, female(OR 0.622 95% CI 0.414-0.936, p=0.023] and non-diabetic patients (OR=0.318, 95% CI 0.241-0.471, p<0.001) were less likely to need intervention.

One third of asymptomatic patients with ESRD had obstructive CAD. Older, male, diabetic patients are more likely to have obstructive CAD and therefore need aggressive management. Non-diabetic, asymptomatic females are unlikely to have obstructive CAD. A risk score will be derived from this model and validated to confirm accurate prediction in this population.

« Back to 2015 American Transplant Congress