Relationship between major adverse cardiac events and angiographic findings in dialysis patients

Fabbian, Fabio; Cacici, G.; Biase, Vincenzo De; Yabarek, T.; Gangemi, Concetta; Franceschini, Lorenzo; Giorgi, Alfredo De; Benussi, Paolo; Lupo, Antonio; Portaluppi, Francesco

doi:10.1007/s11255-010-9821-9

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Experimental evidence regarding the impact of angiographically significant CAD on clinical event rates and long-term survival in patients with ESRD is lacking and observational studies have reported variable results (Table 1). Angiographic CAD has been documented to predict major adverse cardiac events (MACE) [39, 40, 50, 52] and has been associated with increased mortality [31, 48, 49]. Sharma et al [31] reported a significantly worse unadjusted 2-year survival among patients with angiographic CAD compared with patients with normal coronary arteries.…”

Section: Assessment Of Cadmentioning

confidence: 99%

The assessment of coronary artery disease in patients with end-stage renal disease

Poli

Gulsin

Burton

et al. 2019

Clinical Kidney Journal

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Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in patients with ESRD. Coronary artery disease (CAD) is a key disease process, present in ∼50% of the haemodialysis population ≥65 years of age. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. For this reason, the most appropriate approach to the investigation of CAD is the subject of considerable discussion, with practice patterns largely varying between different centres. Traditional imaging modalities are limited in their diagnostic accuracy and prognostic value for cardiac events and survival in patients with ESRD, demonstrated by the large number of adverse cardiac outcomes among patients with negative test results. This review focuses on the current understanding of CAD screening in the ESRD population, discussing the available evidence for the use of various imaging techniques to refine risk prediction, with an emphasis on their strengths and limitations.

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Section: Assessment Of Cadmentioning

confidence: 99%

The assessment of coronary artery disease in patients with end-stage renal disease

Poli

Gulsin

Burton

et al. 2019

Clinical Kidney Journal

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“…The poor correlation between positive angiograms and survival in our study also presents as an apparent contrast with the studies done on ESRD patients on transplant waiting list or posttransplant patients. 11 It can be explained by the positive impact of kidney transplant on patient survival even in high risk groups such as those with CAD, low number of patients in our study, and long-term nature of it. The above discussion however opens room of debate for predictive role of preoperative stress test or coronary angiogram widely employed as part of screening programs and risk stratification strategies in the United States and Europe on patient survival and occurrence of MACE.…”

Section: Discussionmentioning

confidence: 73%

Predictors and Prognostic Implications of Major Adverse Cardiovascular Events after Renal Transplant: 10 Years Outcomes in 321 Patients

et al. 2014

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Renal transplantation is the treatment of choice in patients with end-stage renal disease. Major adverse cardiac events (MACE) are common after renal transplant, especially in the perioperative period, leading to excess morbidity and mortality. The predictors and long-term prognostic implications of MACE are poorly understood. We analyzed predictors and implications of MACE in a cohort of 321 consecutive adult patients, who received renal allograft transplantation between 1995 and 2003 at our institution. The characteristics of 321 patients were: age at transplant 44 ± 13 years, 60% male, 36% diabetes mellitus (DM), left ventricular ejection fraction (LVEF) 60 ± 16%. MACE occurred in 21 patients with cumulative rate of 6.5% over 3 years after renal transplant, 57% occurring within 30 days, 67% within 90 days, and 86% within 180 days. MACE was not predicted by any clinical or pharmacological variables including age, gender, hypertension, DM, prior myocardial infarction, smoking, duration of dialysis, LVEF, or therapy with β-blockers (BB), angiotensin converting enzyme inhibitors, or calcium channel blockers. However, a clinical decision to perform a stress test or a coronary angiogram was predictive of higher MACE rate. MACE, irrespective of type, was independently associated with higher mortality over a period up to 15 years and this seemed to be blunted by BB therapy. MACE rate after renal transplantation decreases over time, most occurring in the first 90 days and is not predicted by any of the traditional risk factors or drug therapies. It is associated with higher long-term mortality.

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“…In another short series of 63 patients, these results were confirmed with 49% of patients (including asymptomatic ones) having significant coronary artery disease. The author showed a relationship between coronary lesions and the cardiovascular events over a 5-year follow-up [ 32 ]. Screening for ischemia and treating it are thus major objectives before renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database

Didier¹,

Yao²,

Legendre³

et al. 2020

JCM

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Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.

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Relationship between major adverse cardiac events and angiographic findings in dialysis patients

Abstract: This observational study confirms that in dialysis patients coronary atherosclerotic damage shown by angiography is strongly related to MACE and that age and severe CAD are major risk factors for MACE.

Cited by 6 publications

References 24 publications

The assessment of coronary artery disease in patients with end-stage renal disease

The assessment of coronary artery disease in patients with end-stage renal disease

Predictors and Prognostic Implications of Major Adverse Cardiovascular Events after Renal Transplant: 10 Years Outcomes in 321 Patients

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database

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