Date: Sunday, June 12, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 304
Background: Diagnosis of coronary artery disease before kidney transplantation is crucial in decreasing morbidity and mortality & avoiding the need for angiography in kidney transplant recipients(KTR).
Methods: We examined the predictive value of non-invasive cardiac testing for KTR and developed an algorithm classifying patients into low, intermediate & high risk groups for cardiovascular events(CVe) post transplant according to degree of association between clinical risk factors & CVe. The proposed algorithm was validated using a separate KTR population & compared with the 2012 American Heart Association(AHA) recommendations. A CVe was defined as post-transplant unstable angina, myocardial infarction, cardiac arrest,or the need for pre-transplant coronary intervention.
Results: A total of 517 KTR in 2 cohorts were retrospectively analyzed. Non-invasive tests had a sensitivity & specificity of 40% & 91%, respectively, in predicting a CVe. Of the 254 KTR in the risk stratification population,(Oct.2007-Dec.2011),198 KTR had non-invasive cardiac testing prior to transplantation. Sixteen patients(6.3%) experienced a CVe. Using clinical risk stratification, 30 high, 172 intermediate,& 52 low-risk KTR were identified. Stratification into the high-risk group predicted a CVe with 44% sensitivity & 90% specificity. In the validation population,263 KTR(Jan.2012-Jun.2014),sensitivity & specificity were very similar,35.2% &91.5%, respectively.
Conclusion: AHA guidelines stratify patients into low (30%) & high risk (70%) groups. Our proposed stratification would reclassify patients into a low risk group (35%) who do not need further testing, a high-risk group (10%) who need pre-transplant testing (angiography or non-invasive). For the intermediate-risk KTR non-invasive cardiac testing may be appropriate. Our stratification is simpler but more discriminatory than the AHA recommendations.
CITATION INFORMATION: Jiamjariyapon T, Townamchai N, Garg N, Pavlakis M, Chandraker A. Validation of a Simplified Cost-Effective Clinical Risk Stratification That Predicts Myocardial Ischemic Events in Kidney Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Jiamjariyapon T, Townamchai N, Garg N, Pavlakis M, Chandraker A. Validation of a Simplified Cost-Effective Clinical Risk Stratification That Predicts Myocardial Ischemic Events in Kidney Transplant Candidates. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/validation-of-a-simplified-cost-effective-clinical-risk-stratification-that-predicts-myocardial-ischemic-events-in-kidney-transplant-candidates/. Accessed March 6, 2021.
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