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Updated: May 5, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Association of Coronary Revascularization Modality and Timing With Outcomes of Acute Coronary Syndrome in Kidney
Oh Jin Kwon1, Esteban Aguayo2, Joseph Hadaya3
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, Department of Surgery, University of California, Los Angeles, California.
Insights
For renal transplant recipients with non-ST-elevation acute coronary syndrome, percutaneous coronary intervention (PCI) shows lower mortality and complication risks than coronary artery bypass grafting (CABG). CABG may reduce repeat procedures but offers timing flexibility.
Area of Science:
- Cardiology and Transplant Medicine
- Cardiovascular Interventions
- Renal Transplantation Outcomes
Background:
- Coronary artery disease (CAD) is a major concern for renal transplant (RTx) recipients.
- Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) presents a significant challenge in this population.
- Optimal revascularization strategies for NSTE-ACS in RTx patients require further investigation.
Purpose of the Study:
- To compare the outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for NSTE-ACS in RTx recipients.
- To evaluate in-hospital mortality, perioperative complications, readmissions, repeat revascularization, and renal allograft failure.
- To assess the impact of revascularization modality and timing on patient outcomes.
Main Methods:
- Retrospective analysis of the Nationwide Readmissions Database (2016-2021).
- Inclusion of RTx recipients (≥18 years) undergoing CABG or PCI for NSTE-ACS.
- Utilized multivariable logistic regression and Royston-Parmar models for risk-adjusted outcome analysis.
Main Results:
- CABG was associated with significantly higher perioperative complications (AOR 3.46) and a trend toward increased mortality (AOR 1.79).
- No significant differences were observed in 90-day readmission or renal allograft failure rates between CABG and PCI.
- CABG demonstrated a lower hazard of repeat revascularization (HR 0.24) but PCI complications increased with delayed intervention.
Conclusions:
- PCI appears to be linked to lower mortality and complication risks compared to CABG in RTx patients with NSTE-ACS.
- CABG may reduce the need for repeat revascularization and offers timing flexibility without compromising renal allograft function.
- The choice of revascularization strategy should consider individual patient factors and risk profiles.
Abstract:
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality among renal transplant (RTx) recipients, with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) representing a disproportionately high burden. However, the optimal revascularization strategy for NSTE-ACS in RTx recipients remains unclear. This retrospective study analyzed the 2016 to 2021 Nationwide Readmissions Database. RTx recipients (≥18 years) undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for NSTE-ACS were included. The primary outcome was in-hospital mortality, while perioperative complications, unplanned 30- and 90-day readmissions, repeat revascularization, and renal allograft failure were also considered. Multivariable logistic regression and Royston-Parmar models were used to identify the risk-adjusted association of revascularization modality, timing, and outcomes. Of an estimated 3,323 patients, 20.5% underwent CABG and 79.5% PCI. Following adjustment, CABG was associated with higher perioperative complications (AOR 3.46, 95% CI 2.31 to 5.19) and demonstrated a trend toward increased mortality risk (AOR 1.79, 95% CI 0.76 to 4.18). Royston-Parmar analysis demonstrated no difference in freedom from readmission or renal allograft failure within 90 days of discharge, but CABG was associated with a lower hazard of repeat revascularization (HR 0.24, 95% CI 0.08 to 0.76). Timing analysis revealed stable mortality rates across intervals for both modalities. While PCI complications increased with longer delays to revascularization, CABG demonstrated a more stable pattern. In conclusion, our findings suggest that PCI appears to be associated with lower risks of mortality and complications compared to CABG in RTx recipients with NSTE-ACS. However, CABG may offer benefits of reduced risk of repeat revascularization and greater flexibility in timing without compromising renal allograft function.
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