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Multivessel coronary revascularization and outcomes in kidney transplant recipients

Colin R Lenihan1, Maria E Montez-Rath, Wolfgang C Winkelmayer

  • 1Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.

Transplant International : Official Journal of the European Society for Organ Transplantation
|August 21, 2013
PubMed

Insights

For kidney transplant patients with multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) showed similar long-term survival and reduced risk of death or myocardial infarction.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation

Background:

  • Coronary artery disease (CAD) is a significant cause of illness and death in kidney transplant recipients.
  • Multivessel coronary disease requires revascularization, with choices between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To compare the long-term outcomes of CABG versus PCI in US kidney transplant recipients with multivessel coronary disease.
  • To evaluate the association of revascularization type with mortality and the composite of death or myocardial infarction (MI).

Main Methods:

  • Retrospective cohort study using the US Renal Data System (1997-2009).
  • Included adult kidney transplant patients with at least 6 months of Medicare A+B coverage undergoing first multivessel coronary revascularization.
  • Compared outcomes using proportional hazards regression and propensity score-matched analyses.

Main Results:

  • 2272 patients were analyzed: 1594 (69%) underwent CABG and 678 (31%) underwent PCI.
  • The estimated 5-year survival rate was 55% across both groups.
  • No significant difference was found between CABG and PCI for death (aHR=1.08) or the composite of death/MI (aHR=1.07).

Conclusions:

  • In kidney transplant recipients with multivessel coronary disease, CABG and PCI offer comparable long-term survival.
  • Neither revascularization strategy demonstrated superiority in reducing the composite endpoint of death or myocardial infarction.

Keywords:
coronary artery bypass graftcoronary artery diseasekidney transplantpercutaneous coronary intervention

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