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Screening for significant coronary artery disease in high-risk renal transplant candidates
Luís Henrique W Gowdak1, Flávio J de Paula, Luiz Antonio M César
1Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. luis.gowdak@incor.usp.br
Insights
High-risk renal transplant candidates with diabetes, peripheral arterial disease, or prior myocardial infarction face increased coronary artery disease (CAD) and major adverse coronary events (MACE). Early identification and intervention are crucial for these patients.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- Renal transplant candidates have a higher risk of coronary artery disease (CAD), a key predictor of major adverse coronary events (MACE).
- Coronary angiography, while definitive, is invasive and costly, necessitating identification of clinical predictors for significant CAD in this population.
Purpose of the Study:
- To identify clinical predictors of significant CAD (stenosis >=70%) in high-risk patients undergoing evaluation for renal transplantation.
Main Methods:
- A cohort of 301 hemodialysis patients (mean age 57 years, 73% male) with inclusion criteria of diabetes, cardiovascular disease evidence, or age >=50 years underwent clinical evaluation and coronary angiography.
- Data collected included traditional risk factors (hypertension, obesity, dyslipidemia, diabetes, smoking) and existing cardiovascular conditions (peripheral arterial disease, angina, stroke, myocardial infarction, heart failure).
Main Results:
- Significant CAD was identified in 45.2% of patients.
- Diabetes (OR=1.82), peripheral arterial disease (PAD) (OR=2.50), and previous myocardial infarction (MI) (OR=7.75) were independently associated with significant CAD.
- The prevalence of CAD and incidence of MACE significantly increased with the presence of these predictors, with CAD rates rising from 26% to 100% and MACE incidence increasing two to sixfold.
Conclusions:
- High-risk end-stage renal disease patients exhibit a high prevalence of CAD and incidence of MACE.
- Diabetes, PAD, and prior MI are critical indicators for increased risk of CAD and MACE in this cohort.
- These patients warrant referral for invasive diagnostic procedures to assess for significant CAD and cardiovascular complications.
Background:
Renal transplant candidates are at an increased risk for coronary artery disease (CAD), a strong predictor of cardiovascular events [major adverse coronary events (MACE)]. Coronary angiography is a costly, risky, invasive procedure. We sought to determine clinical predictors of significant CAD (stenosis > or =70%) in high-risk renal transplant candidates.
Methods:
Clinical evaluation and coronary angiography were performed in 301 patients (57+/-8 years, 73% men) on hemodialysis for 32 months (median). Patients were followed-up for 22 months (median). Inclusion criteria were diabetes (type 1 or 2), evidence of cardiovascular disease, or age > or =50 years. Risk factors included hypertension (93.7%), overweight/obesity (54.3%), dyslipidemia (44.9%), diabetes (42.1%), and smoking (24.3%). Cardiovascular disease was found as follows: peripheral arterial disease (PAD) (31.2%), angina (28.1%), stroke (12.9%), myocardial infarction (MI) (10.3%), and heart failure (9.3%).
Results:
Significant CAD was found in 136 individuals (45.2%). Diabetes [odds ratio (OR)=1.82; 95% confidence interval (CI)=1.08-3.07], PAD (OR=2.50; 95% CI=1.44-4.37), and previous MI (OR=7.75; 95% CI=3.03-23.98) were associated with significant CAD. The prevalence of significant CAD increased with the number of clinical predictors from 26% (none) to 100% (all present) (P<0.0001). The incidence of fatal/nonfatal MACE increased two, four, and sixfold in those with diabetes, PAD, or previous MI, respectively (P<0.0001).
Conclusions:
In high-risk patients with end-stage renal disease, the prevalence of CAD and the incidence of MACE were high. Significant CAD or cardiovascular complications were not related to the majority of classic risk factors. Patients with diabetes, PAD, or previous MI are at higher risk of CAD, MACE, or both and, thus, must be referred for invasive diagnostic procedures.
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