Key result
Standardized preoperative cardiac risk assessment fails to reduce perioperative cardiac events versus historical controls.
Why the study?
Perioperative cardiovascular events are common in renal transplantation and non-invasive cardiac stress tests are recommended for high-risk candidates, but the benefit of a standardized preoperative cardiac risk assessment programme was unclear.
Does a standardized preoperative cardiac risk assessment programme reduce perioperative cardiac events in asymptomatic high-risk renal transplant candidates?
Cohort (n=332)
Does a standardized preoperative cardiac risk assessment programme reduce perioperative cardiac events in asymptomatic high-risk renal transplant candidates?
Absolute Event Rate: 3.8% vs 7.6%
p-value: p=0.136
Routine non-invasive cardiac stress testing in asymptomatic high-risk renal transplant candidates did not significantly reduce perioperative cardiac events compared to historical controls.
Standardized preoperative cardiac screening yielded no significant event reduction; leaves open the value of routine stress testing in high-risk renal transplant candidates.
BACKGROUND: Perioperative cardiovascular events in renal transplantation are common and non-invasive cardiac stress tests are recommended in high-risk renal transplant candidates. In 2004, we introduced a standardized preoperative cardiac risk assessment programme with the aim of reducing perioperative cardiac events. METHODS: Since 2004, all asymptomatic high-risk renal transplant candidates had to undergo non-invasive cardiac stress testing. Patients with a positive stress test went for a coronary angiography and if indicated for revascularization. The incidence of perioperative cardiac events (≤30 days of transplantation) was analysed in all high-risk patients who received a transplantation (screening group) and compared with high-risk renal transplant recipients evaluated in the 4 years before the introduction of the cardiac assessment programme (historical control group). RESULTS: Since 2004, 227 of 349 asymptomatic high-risk renal transplant candidates underwent non-invasive cardiac stress testing. In 15 patients (6.6%), significant ischaemia was found. Ten of these 15 patients underwent coronary angiography (eight patients had significant coronary artery disease and in five patients, percutaneous coronary intervention was performed). One hundred and sixty of 349 renal transplant candidates have received renal transplantation so far (screening group). In the screening group, 6 perioperative cardiac events (3.8%) occurred compared to 13 perioperative events (7.6%) in the historical control group (n = 172) (P = 0.136). CONCLUSIONS: The incidence of significant cardiac ischaemia in high-risk renal transplant patients was low and was followed by revascularization in a small percentage of patients. No significant decrease in perioperative cardiac events was observed after the introduction of the standardized cardiac assessment programme.
No takes yet. Share an insight, caveat, or question.
Aalten et al. (2011) conducted a cohort in Asymptomatic high-risk renal transplant candidates (n=332). Standardized preoperative cardiac risk assessment programme vs. Historical control group was evaluated on Perioperative cardiac events (≤30 days of transplantation) (p=0.136). A standardized preoperative cardiac risk assessment programme did not significantly reduce perioperative cardiac events compared to historical controls (3.8% vs 7.6%; P=0.136).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: