Supported by Fundação de Amparo Á Pesquisa do Estado de São Paulo (FAPESP) and Zerbini Foundation, Brazil.
Influence of coronary artery disease assessment and treatment in the incidence of cardiac events in renal transplant recipients
Article first published online: 16 NOV 2009
© 2009 John Wiley & Sons A/S
Volume 24, Issue 4, pages 474–480, July/August 2010
How to Cite
De Lima, J. J.G., Gowdak, L. H.W., De Paula, F. J., Arantes, R. L., Ianhez, L. E., Ramires, J. A.F. and Krieger, E. M. (2010), Influence of coronary artery disease assessment and treatment in the incidence of cardiac events in renal transplant recipients. Clinical Transplantation, 24: 474–480. doi: 10.1111/j.1399-0012.2009.01150.x
- Issue published online: 12 AUG 2010
- Article first published online: 16 NOV 2009
- Accepted for publication 30 July 2009
- coronary artery disease;
- kidney transplantation
De Lima JJG, Gowdak LHW, de Paula FJ, Arantes RL, Ianhez LE, Ramires JAF, Krieger EM. Influence of coronary artery disease assessment and treatment in the incidence of cardiac events in renal transplant recipients. Clin Transplant 2010: 24: 474–480. © 2009 John Wiley & Sons A/S.
Abstract: Background: The best strategy for pre-transplant investigation and treatment of coronary artery disease (CAD) is controversial.
Methods: We evaluated 167 renal transplant recipients before transplantation to determine the incidence of cardiac events and death. We performed clinical evaluations and myocardial scans in all patients and coronary angiography in select patients.
Results: Asymptomatic patients with normal myocardial scans (n = 57) had significantly fewer cardiac events (log-rank = 0.0002) and deaths (log-rank = 0.0005) than did patients with abnormal scans but no angiographic evidence of CAD (n = 76) and individuals with CAD (n = 34) documented angiographically. CAD increased the probability of events (HR = 2.27, % CI 1.007–5.11; p = 0.04). The incidence of cardiac events (log-rank = 0.349) and deaths (log-rank = 0.588) was similar among patients treated medically (n = 23) or by intervention (n = 11).
Conclusion: Asymptomatic patients with normal myocardial scans had a better cardiac prognosis than did patients with or without CAD and positive for myocardial ischemia. Patients with altered scan and CAD had the poorer outcome. Guideline-oriented medical treatment is safe and yields results comparable to coronary intervention in renal transplant patients with CAD. The data do not support pre-emptive myocardial revascularization for renal transplant candidates.