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Cardiac survival after pre-emptive coronary angiography in transplant patients and those awaiting transplantation
Nicola Kumar1, Christopher S R Baker, Kakit Chan
1Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. nicky.kumar@nhs.net
Insights
Pre-emptive coronary revascularization before heart transplantation significantly improves survival rates for patients awaiting transplants. This strategy benefits both those transplanted and those remaining on dialysis for a deceased donor.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Surgery
Background:
- Growing interest in expediting heart transplantation by bypassing pre-treatment for coronary artery disease.
- Standard practice involves offering coronary revascularization if indicated before transplantation.
Purpose of the Study:
- To evaluate the impact of pre-emptive coronary revascularization on survival outcomes in patients assessed for heart transplantation.
- To compare outcomes for wait-listed patients who underwent revascularization versus those who did not.
Main Methods:
- Retrospective analysis of 657 patients undergoing pretransplant coronary angiography (2006-2009).
- Assessment of survival rates based on wait-listing status, revascularization, and transplantation.
- Follow-up included cardiac event-free survival at 1 and 3 years.
Main Results:
- Wait-listed patients demonstrated significantly higher survival (98.9% at 1 year, 95.3% at 3 years) compared to non-wait-listed patients.
- Patients undergoing revascularization followed by transplantation had excellent cardiac event-free survival (98.0% at 1 year, 88.4% at 3 years).
- Survival was also favorable for revascularized patients awaiting deceased donor transplants (94.0% at 1 year, 90.0% at 3 years).
Conclusions:
- Pre-emptive coronary revascularization is associated with excellent survival rates in heart transplant candidates.
- This approach benefits patients who are subsequently transplanted and those awaiting deceased donor organs while on dialysis.
Background And Objectives:
Recent interest has focused on wait listing patients without pretreating coronary artery disease to expedite transplantation. Our practice is to offer coronary revascularization before transplantation if indicated.
Design, Setting, Participants, & Measurements:
Between 2006 and 2009, 657 patients (427 men, 230 women; ages, 56.5 ± 9.94 years) underwent pretransplant assessment with coronary angiography. 573 of 657 (87.2%) patients were wait listed; 247 of 573 (43.1%) patients were transplanted during the follow-up period, 30.09 ± 11.67 months.
Results:
Patient survival for those not wait listed was poor, 83.2% and 45.7% at 1 and 3 years, respectively. In wait-listed patients, survival was 98.9% and 95.3% at 1 and 3 years, respectively. 184 of 657 (28.0%) patients were offered revascularization. Survival in patients (n = 16) declining revascularization was poor: 75% survived 1 year and 37.1% survived 3 years. Patients undergoing revascularization followed by transplantation (n = 51) had a 98.0% and 88.4% cardiac event-free survival at 1 and 3 years, respectively. Cardiac event-free survival for patients revascularized and awaiting deceased donor transplantation was similar: 94.0% and 90.0% at 1 and 3 years, respectively.
Conclusions:
Our data suggest pre-emptive coronary revascularization is not only associated with excellent survival rates in patients subsequently transplanted, but also in those patients waiting on dialysis for a deceased donor transplant.
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