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Acute coronary syndromes in the peri‐operative period after kidney transplantation in United States
Author(s) -
Goyal Abhinav,
Lo Kevin Bryan,
Chatterjee Kshitij,
Mathew Roy O.,
McCullough Peter A.,
Bangalore Sripal,
Rangaswami Janani
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14083
Subject(s) - medicine , acute coronary syndrome , kidney disease , coronary artery disease , transplantation , kidney transplantation , retrospective cohort study , case fatality rate , risk factor , cohort , acute kidney injury , myocardial infarction , cardiology , surgery , epidemiology
Abstract Introduction Chronic kidney disease is an independent risk factor for cardiovascular disease. Despite careful preoperative evaluation, there is a risk of acute coronary syndromes after kidney transplant. Methods The National Inpatient Sample for the years 2004‐2013 was used for this retrospective cohort study. All adult patients undergoing kidney transplantation were identified using the appropriate ICD‐9‐CM codes. Multivariate logistic regression was used to identify predictors of acute coronary syndromes in the peri‐operative period after kidney transplantation. Results A total of 147 431 kidney transplants were performed from 2004 through 2013 in the United States. The average peri‐operative in‐hospital mortality was 0.5%. Acute coronary syndrome occurred in 1.3% patients in the peri‐operative period. Half of patients with acute coronary syndromes had pre‐existing coronary artery disease. The strongest predictors of acute coronary syndromes included older age: 45‐64 years. OR 3.28 95% CI (1.85‐5.83), ≥65 years. OR 4.84 (2.59‐9.05), race: African American, OR 0.66 (0.47‐0.93) and pre‐existing coronary artery disease OR 3.83 (2.84‐5.15). The case fatality rates were 16.9% and 5.3% for STEMI and NSTEMI, respectively. The overall mortality for any ACS event was 7.1%. Conclusion Acute coronary syndrome in the immediate peri‐operative period after kidney transplantation is rare but is associated with high rates of mortality.