Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

Abstract

SummaryBackground and objectives Recent interest has focused on wait listing patients without pretreating coronary artery disease to expedite transplantation. Our practice is to offer coronary revascularization before transplantation if indicated. Between 2006 and 2009, 657 patients (427 men, 230 women; ages, 56.5 Ϯ 9.94 years) underwent pretransplant assessment with coronary angiography. 573 of 657 (87.2%) patients were wait listed; 247 of 573 (43.1%) patients were transplanted during the follow-up period, 30.09 Ϯ 11.67 months. Design, setting, participants, & measurementsResults Patient survival for those not wait listed was poor, 83.2% and 45.7% at 1 and 3 years, respectively. In wait-listed patients, survival was 98.9% and 95.3% at 1 and 3 years, respectively. 184 of 657 (28.0%) patients were offered revascularization. Survival in patients (n ϭ 16) declining revascularization was poor: 75% survived 1 year and 37.1% survived 3 years. Patients undergoing revascularization followed by transplantation (n ϭ 51) had a 98.0% and 88.4% cardiac event-free survival at 1 and 3 years, respectively. Cardiac event-free survival for patients revascularized and awaiting deceased donor transplantation was similar: 94.0% and 90.0% at 1 and 3 years, respectively. ConclusionsOur data suggest pre-emptive coronary revascularization is not only associated with excellent survival rates in patients subsequently transplanted, but also in those patients waiting on dialysis for a deceased donor transplant.

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

“…137 Among the 657 patients who underwent angiography in 2006 to 2009, significant CAD (defined as Ͼ75% stenosis of 1 or more coronary arteries, Ͼ50% left main stem lesion, or an equivocal lesion with flow limitation) was found in 28%, of whom 55% were free of symptoms and prior CAD history. Those with significant CAD who underwent revascularization followed by transplantation (nϭ51; 1-year survival, 100%; 3-year survival, 97%) or by continued waiting (nϭ177; 1-year survival, 95%; 3-year survival, 81%) had survival superior to that of the 16 patients who declined revascularization (1-year survival, 75%; 3-year survival, 37%).…”

Multivessel Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in ESRD

“…1 Coronary heart disease affects 30%-60% of patients with ESRD, and it usually involves multiple vessels, proximal lesions, heavy calcifications, or diffuse disease. [2][3][4] Because of the high burden and poor prognosis of coronary disease in this patient population, optimal management of coronary heart disease-particularly the choice of revascularization modality-is a critical clinical issue.…”

Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis

“…Therefore, it is necessary to recognize that the findings of Manske et al [4] are limited due to a small sample size with suboptimal medical therapy and optimal surgical treatment of diabetics leading to a positive finding. More recently, Kumar et al [21] have noted that preemptive revascularization prior to transplantation leads to increased survival at 1 and 3 years posttransplant. The conclusions of this study are limited as it was nonrandomized and participants were asked if they wanted revascularization or not.…”