Cardiovascular (CV) assessment in prerenal transplant patients varies by center. Current
guidelines recommend stress testing for candidates if ≥3 CV risk factors exist. We
evaluated the CV assessment and management in 685 patients referred for kidney transplant
over a 7-year period. All patients had CV risk factors, and the most common cause
of end-stage renal disease was diabetes. Thirty-three percent (n = 229) underwent
coronary angiography. The sensitivity of stress testing to detect obstructive coronary
artery disease (CAD) was poor (0.26). Patients who had no CAD, nonobstructive CAD,
or CAD with intervention had significantly higher event-free survival compared with
patients with obstructive CAD without intervention. There were no adverse clinical
events (death, myocardial infarction, stroke, revascularization, and graft failure)
within 30 days post-transplant in patients who had preoperative angiography (n = 77).
Of the transplanted patients who did not have an angiogram (n = 289), there were 8
clinical events (6 myocardial infarctions) in the first 30 days. In conclusion, our
results indicate that stress testing and usual risk factors were poor predictors of
obstructive CAD and that revascularization may prove beneficial in these patients.
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Article info
Publication history
Published online: October 18, 2015
Accepted:
October 9,
2015
Received in revised form:
October 9,
2015
Received:
June 18,
2015
Footnotes
Statistical analyses and the project described were supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 8UL1TR000105 (formerly UL1RR025764). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
See page 149 for disclosure information.
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
