Coronary angiography is a better predictor of mortality than noninvasive testing in patients evaluated for renal transplantation

Enkiri, Sean A.; Taylor, Angela M.; Keeley, Ellen C.; Lipson, Lewis C.; Gimple, Lawrence W.; Ragosta, Michael

doi:10.1002/ccd.22656

Cited by 14 publications

(8 citation statements)

References 36 publications

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“…On the contrary, coronary angiogram predicted MACE as well as survival not only in univariate model but also in multivariate model. This observation thus extends the observations of other studies done by De Lima et al 6 and Enkiri et al 12 who have argued for the superiority of the coronary angiogram in predicting survival or events over stress imaging. However, the low rate of angiographic positivity in our study makes us suggest that careful risk stratification using clinical judgment is the primary tool of prediction for MACE.…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

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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“…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%

“…Data regarding survival prediction, however, are more variable. Several studies identified an abnormal finding on MPS to be an independent predictor of mortality in RTC and ESRD populations [51, 112, 115, 119], whereas others found no association between MPS results and survival [39, 49, 110, 113, 116, 120]. A meta-analysis by Wang et al found that MPS was as good as ICA at predicting MACE and cardiovascular mortality, but worse than ICA for all-cause mortality [53].…”

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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“…Coronary artery disease (CAD) and myocardial ischaemia frequently occur in patients with end‐stage renal disease (ESRD), and are directly associated with increased risk of mortality . CAD in ESRD is characterized by media thickening (Mönckeberg media sclerosis) and heavily calcified plaques .…”

Section: Introductionmentioning

confidence: 99%

Nonthyroidal illness: a risk factor for coronary calcification and arterial stiffness in patients undergoing peritoneal dialysis?

et al. 2013

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Objectives. Low triiodothyronine levels, as part of the nonthyroidal illness syndrome, are common in dialysis patients and have repeatedly been shown to be associated with increased (cardiovascular) mortality rates. We hypothesized that increased vascular calcification may mediate this relationship.Methods. A total of 84 patients from the Stockholm region receiving maintenance peritoneal dialysis were included in the study. Serum concentrations of free triiodothyronine (fT3), thyroxine and thyroidstimulating hormone were measured. Coronary artery calcium (CAC) scores were assessed by cardiac computed tomography scans. Surrogates of arterial stiffness included aortic diastolic and systolic blood pressures, pulse pressure, augmentation pressure and Buckberg's subendocardial viability ratio measured by pulse waveform analyses. Patients were subsequently followed, and events of death and censoring were recorded. Thyroid hormone concentrations were associated with CAC scores, measures of arterial stiffness and allcause mortality. The associations between CAC scores and arterial stiffness surrogates and mortality were also determined to evaluate a possible causal pathway.Results. Both CAC scores and arterial stiffness surrogates were substantially higher in individuals with low fT3 levels. These associations persisted in multivariate logistic and linear regression analyses. During a median (interquartile range) follow-up of 32 (22-42) months, 24 patients died. Both fT3 levels below the median value [HR crude 4.1, 95% confidence interval (CI) 1.4-12.6] and CAC scores above the median value (HR crude 5.8, 95% CI 1.7-20.1) were strongly associated with mortality.Conclusions. In patients undergoing peritoneal dialysis, fT3 levels were strongly associated with arterial stiffness, coronary artery calcification and mortality. We speculate that the association between nonthyroidal illness and mortality may be partly mediated by acceleration of vascular calcification.

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Coronary angiography is a better predictor of mortality than noninvasive testing in patients evaluated for renal transplantation

Cited by 14 publications

References 36 publications

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

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

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

Nonthyroidal illness: a risk factor for coronary calcification and arterial stiffness in patients undergoing peritoneal dialysis?

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