Abstract 17035: Myocardial Ischemia or Degree of Coronary Artery Stenosis as Predictors of Events in Renal Transplant Candidates
Background: Patients (pt) with chronic kidney disease (CKD) stage V are at greater risk for major adverse cardiovascular events (MACE), mostly due to coronary artery disease (CAD).
Objective: To define the interplay between myocardial ischemia and the degree of coronary stenosis as predictors of MACE (sudden death, myocardial infarction or unstable angina, stroke, or unplanned myocardial revascularization) in pt with CKD on the waiting list for renal transplantation.
Methods: 459 pt with CKD on dialysis (56±9 years-old, 70% men) at high-risk for CAD underwent myocardial perfusion assessment by cardiac scintigraphy (SPECT) with dipyridamole, and coronary angiography, regardless of symptoms or results of non-invasive tests. The median follow-up was 26 (1 to 108) months. Cox proportional hazards model was used for the event-free survival probability for pt with and without significant CAD (stenosis ≥ 70%), and for pt with and without myocardial perfusion defects (reversible and/or fixed).
Results: There were 100 fatal/non-fatal MACE. In pt with normal perfusion scans (n=232), there were 81 (35%) with significant CAD. In this group, the risk ratio (RR) and 95% confidence interval (95%CI) for MACE were 1.68 [1.19–2.41] (P=0.016). In pt with abnormal perfusion scans (n=227), there were 145 (64%) with CAD ≥ 70%, with a RR for MACE of 1.2 (95%CI=0.98–1.46) (P=0.12). On the other hand, in pt without significant CAD (n=233), finding an abnormal myocardial perfusion scan (n=82; 35%) was marginally associated with an increased risk of MACE (RR=1.48, 95%CI=1.00–2.20; P=0.08), whereas in pt with significant CAD (n=226), finding a normal perfusion scan (n=81; 36%) was not associated with a lower rate of events (RR=0.81, 95%CI=0.54–1.23; P=0.36).
Conclusions: In pt with CKD and high-risk for CAD, in those with normal myocardial perfusion scans the prevalence of significant CAD is high. Moreover, in pt with normal perfusion scans, coronary angiography does help to identify pt at risk of MACE, should significant CAD be found. An abnormal myocardial perfusion scan was marginally associated with an increased risk of MACE only in pt without significant CAD. By contrast, in pt with significant CAD, the risk of MACE seems to be independent of the results of perfusion scans.
- © 2010 by American Heart Association, Inc.