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Coronary Artery Disease in a Large Renal Transplant Population: Implications for Management
Author(s) -
Kahn M. R.,
Fallahi A.,
Kim M. C.,
Esquitin R.,
Robbins M. J.
Publication year - 2011
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2011.03734.x
Subject(s) - medicine , coronary artery disease , hazard ratio , transplantation , percutaneous coronary intervention , cardiology , revascularization , population , kidney transplantation , kidney disease , retrospective cohort study , surgery , end stage renal disease , cardiac catheterization , disease , myocardial infarction , confidence interval , environmental health
Coronary artery disease (CAD) accounts for approximately one‐half of the sizable mortality in patients with end‐stage renal disease who have undergone transplantation. The study was a retrospective review of 1460 patients who underwent renal transplantation at the Mount Sinai Medical Center from January 1, 2000 to October 31, 2009. Noninvasive stress testing was performed in 848 patients (88.1%) with 278 patients (32.8%) having abnormal results. Cardiac catheterization was performed in 357 patients (37.1%) and of these, 212 patients had obstructive disease (59.4%). At 5 years posttransplant, there was no statistically significant difference between those with nonobstructive CAD and those who required percutaneous or surgical interventions (adjusted hazard ratio [aHR], 1.243; CI 95%, 0.513–3.010; p = 0.630). Those with medically managed obstructive CAD had significantly higher rates of death at the 5‐year period when compared to those who received percutaneous intervention (aHR, 3.792; CI 95%, 1.320–10.895; p = 0.013) or those who received coronary artery bypass grafting (aHR, 6.691; CI 95%, 1.200–37.323). Because noninvasive imaging is poorly predictive of coronary disease in this high‐risk population, an anatomic diagnosis is recommended. Revascularization may result in improved long‐term outcomes.