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Published on: April 12, 2021
Outcomes of Interventional Management of Coronary Artery Disease in Kidney Transplant Recipients
Sanchit Chawla1, Hassan Mehmood Lak1, Yasser Sammour2
1Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
Insights
Percutaneous coronary intervention (PCI) before kidney transplant (KT) is safe for patients with coronary artery disease. Long-term outcomes after PCI are comparable to medical management in this population.
Area of Science:
- Cardiology
- Nephrology
- Transplantation
Background:
- Cardiovascular disease is a leading cause of death in kidney transplant recipients.
- Patients with end-stage renal disease are often excluded from coronary artery revascularization trials.
- This study compares outcomes of percutaneous coronary intervention (PCI) versus medical management before kidney transplantation (KT).
Purpose of the Study:
- To compare long-term outcomes in kidney transplant candidates undergoing PCI versus medical management.
- To evaluate the safety and efficacy of PCI in patients with coronary artery disease awaiting KT.
Main Methods:
- Retrospective cohort study of 272 patients undergoing coronary catheterization before KT (2008-2019).
- Compared outcomes between 52 patients who underwent PCI and 220 patients managed medically.
- Primary endpoint was all-cause mortality.
Main Results:
- No significant difference in 10-year all-cause mortality between PCI and medically managed groups.
- Patients undergoing PCI had a higher prevalence of multivessel coronary artery disease.
- Median time to KT was longer in the PCI group.
Conclusions:
- Percutaneous coronary intervention (PCI) is a safe treatment option for kidney transplant candidates with coronary artery disease.
- PCI before kidney transplant leads to comparable long-term mortality rates as medical management.
Background:
Cardiovascular disease is the most common cause of death among kidney transplant (KT) recipients. Trials routinely exclude patients with end-stage renal disease when assessing the effect of coronary artery revascularization. We looked to compare long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) before KT with those managed medically.
Methods:
We identified all patients who underwent coronary artery catheterization before KT from January 2008 to November 2019 at the Cleveland Clinic. The primary endpoint was all-cause mortality.
Results:
A total of 272 patients were included, of whom 52 (19.11%) underwent PCI, and the remaining 220 patients were managed medically. The median age in the PCI group was 57.4 years (interquartile range [IQR], 46.9-61.2 years), whereas it was 53.9 years (IQR, 44.6-61 years) in the group medically managed. Baseline characteristics including sex, race, hypertension, diabetes, smoking, and hyperlipidemia were comparable in both groups. The median time to KT was 2.4 years (IQR, 1-5 years) in the PCI group vs 1.2 years (IQR, 0.6-3.3 years) in the medically managed group (P = .001). Among patients who underwent PCI, 40.4% had single vessel disease and 59.6% had multivessel disease compared with 16.8% and 28.6%, respectively, in the medically managed group (P < .001). Overall, there was no difference in mortality in the PCI group compared with the medically managed group after 10 years of follow-up (P = .416).
Conclusions:
Patients with coronary artery disease can be safely treated with PCI before KT and have comparable outcomes to those who are managed medically.
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