Key result
Diabetes mellitus, prior coronary artery disease, and familial history of coronary artery disease were statistically significant risk factors for severe coronary artery disease in renal transplant recipients.
Why the study?
What are the clinical predictors of severe coronary artery disease during preoperative cardiac risk assessment in renal transplant recipients?
Observational (n=216)
No
What are the clinical predictors of severe coronary artery disease during preoperative cardiac risk assessment in renal transplant recipients?
In renal transplant candidates, diabetes, prior CAD, and family history of CAD strongly predict severe coronary artery disease, suggesting these high-risk patients may benefit from direct coronary angiography rather than non-invasive stress testing.
Supports targeted stress testing or direct angiography in renal transplant candidates with multiple risk factors; leaves open need for prospective validation before practice change.
OBJECTIVES: Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease. MATERIALS AND METHODS: We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded. RESULTS: We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant. CONCLUSIONS: Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.
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Yılmaz et al. (2017) conducted an observational in Renal transplant recipients (n=216). Risk factors (diabetes mellitus, prior coronary artery disease, familial history of coronary artery disease) vs. Absence of risk factors was evaluated on Severe coronary artery disease. Diabetes mellitus, prior coronary artery disease, and familial history of coronary artery disease were statistically significant risk factors for severe coronary artery disease in renal transplant recipients.
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