Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
- Predicting Obstructive Coronary Artery Disease in Asymptomatic Renal Patients Undergoing Renal Transplantation
- Clinical Significance of Multidetector Coronary Computed Tomography Angiography to Evaluate the Prevalence and Severity of Coronary Artery Disease in Asymptomatic Kidney Transplantation Recipients
*Purpose: Patient’s with ESRD undergoing evaluation for kidney transplantation routinely undergo screening for coronary artery disease (CAD). Screening recommendations in this population differ between ACC/AHA and K/DOQI guidelines, are derived primarily from expert opinion, and have significant variability in institutional implementation. To date, very few studies have assessed the implications of obstructive CAD and PCI in pre-renal transplantation.
*Methods: This study is a single-center, retrospective review of patients who underwent diagnostic coronary angiography prior to listing for renal transplantation. Patients were categorized into two groups: those without obstructive CAD who did not require revascularization versus those who required PCI prior to listing for kidney transplantation. Demographic and clinical comparisons were made between the groups. Primary endpoints were death and MACE. Patients undergoing CABG were excluded from this study.
*Results: There were 225 patients who had non-obstructive CAD and 189 patients who underwent PCI. Demographic data between diagnostic versus PCI groups are shown in Table 1. Nearly all patients had hypertension. Patients who underwent PCI tended to be older and had a higher prevalence of hyperlipidemia (p<0.05). In multi-variate analysis, history of heart failure and hyperlipidemia were found to be independent predictors of adverse clinical outcomes. There was a significant difference in MACE between the two groups. In the diagnostic group, 5-year freedom from MACE was 89.3%, and 10-year freedom was 74.0%. In the PCI group, 5-year freedom from MACE was 61.0% and 10-year freedom was 37.4%. There was no significant difference in 10-year survival between the two groups (Diagnostic: 62.3%, PCI 62.6%, P = 0.98).
*Conclusions: Incidence of obstructive CAD requiring PCI is significant in this cohort of patients undergoing screening angiography. Amongst patients undergoing invasive screening for CAD with coronary angiography, the patients with obstructive CAD requiring PCI were more likely to experience MACE or require repeat revascularization, compared to those requiring only a diagnostic coronary angiogram. Interestingly, there was no difference in overall long-term survival between the two groups despite differences in MACE and revascularization.
|Non-Obstructive CAD (n=225)||Obstructive CAD (n=189)||p-value|
|Age, Mean (SD)||55.9 (10.7)||58.5 (9.09)||0.007|
|Diabetes, n(%)||138 (61.3%)||125 (66.1%)||0.36|
|Historyof Heart Failure,n(%)||40 (17.8%)||37 (19.6%)||0.7|
|Hyperlipidemia, n(%)||105 (46.7%)||144 (76.2%)||<0.0001|
To cite this abstract in AMA style:Shah M, Yung A, Ebinger J, Mirocha J, Huang E, Geft D, Peng A, Azarbal B. Risk Factors for Adverse Clinical Outcomes amongst Renal Transplant Candidates Undergoing Screening Angiography for Coronary Artery Disease [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-adverse-clinical-outcomes-amongst-renal-transplant-candidates-undergoing-screening-angiography-for-coronary-artery-disease/. Accessed April 15, 2021.
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