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Association of Moderate Coronary Artery Disease Burden With Major Adverse Cardiovascular Events Following Kidney

Ananta Sriram1, Spencer Hobbs1, Venkata Peddada2

  • 1Saint Louis University School of Medicine, SSM-Saint Louis University Hospital, St. Louis, MO.

Transplantation Proceedings
|August 19, 2026
PubMed

Insights

Kidney transplant recipients with moderate coronary artery disease (CAD) face increased risks. Three-vessel disease significantly elevates the likelihood of major adverse cardiovascular events (MACE) post-transplant.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation

Background:

  • Coronary artery disease (CAD) is a primary cause of death in kidney transplant (KT) recipients.
  • The clinical significance of moderate, nonobstructive CAD in KT candidates is not well understood.
  • Current guidelines often focus on severe CAD, leaving moderate disease management ambiguous.

Purpose of the Study:

  • To investigate the association between moderate coronary artery disease (50-70% stenosis) and major adverse cardiovascular events (MACE) after kidney transplantation.
  • To determine if the extent of moderate CAD impacts post-transplant cardiovascular outcomes.
  • To identify specific coronary artery involvement associated with increased MACE risk.

Main Methods:

  • Retrospective analysis of 174 kidney transplant recipients with moderate CAD who underwent pre-transplant coronary angiography without revascularization.
  • Patients were categorized into groups based on the number of affected coronary vessels: none (0V), 1-2 vessels (1-2V), and 3 vessels (3V).
  • Primary outcome assessed was post-KT MACE, including cardiovascular death, myocardial infarction, stroke, and revascularization procedures.

Main Results:

  • Major adverse cardiovascular events (MACE) occurred in 9.4% (0V), 14.8% (1-2V), and 37.5% (3V) of patients.
  • Three-vessel (3V) moderate CAD was independently associated with a significantly higher risk of MACE (HR 3.30, 95% CI: 1.27-8.56).
  • Involvement of the left anterior descending artery (LAD) also showed an independent association with MACE (P = .004).

Conclusions:

  • Moderate coronary artery disease, particularly three-vessel involvement, poses a significant risk for major adverse cardiovascular events following kidney transplantation.
  • Left anterior descending artery involvement is an independent predictor of adverse cardiovascular outcomes in this population.
  • These findings suggest a need to consider the extent and location of moderate CAD in pre-transplant risk stratification for kidney transplant candidates.

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