Abstract 16874: Predictors of Major Adverse Cardiac Events in Renal Transplant Recipients
Background: Renal transplantation has become the treatment of choice in end stage renal disease patients. Though the incidence of acute myocardial infarction is reduced after kidney transplant as compared to patients awaiting kidney transplant, major adverse cardiac events (MACE) are still common after renal transplant, especially in early post operative period.
Methods: We reviewed medical records of 321 consecutive adult patients from our institution who received renal allograft transplantation between1995 and 2003. Details on cardiac risk factors, medications, stress test results, coronary angiogram and coronary intervention were collected and related to MACE.
Results: The characteristics of 321 patients were as follows: age at transplant 49±13 years, 40% male, 37% diabetics, 87% with hypertension, LV ejection fraction 58±17%. MACE occurrd in 21 patients with cumulative MACE rate of 6.5% over the 3 years after renal transplant, most of them (57%) occurring within 30 days, 67% within 90 days and 84% within 180 days. MACE was not predicted by any of the clinical or pharmacological variables including age, gender, hypertension, diabetes, prior myocardial infarction, smoking, duration of dialysis, LV ejection fraction, or therapy with beta blockers, angiotensin converting enzyme inhibitors or calcium channel blockers. However, a clinical decision to perform a stress test or a coronary angiogram was predictive of a higher MACE rate. The MACE rate was 12.3% in the group with positive stress tests (n=65), 6.1 % in those with negative stress tests (n=134), and 4.1% in the those not referred for a stress test (n=122) (p=0.03). Patients who underwent pre-transplant coronary angiography (n=91), regardless of coronary anatomy, had a higher MACE rate (11 vs 4.8%, p=0.04) than those who did not undergo coronary angiography (n=230).
Conclusions: (1) The MACE rate following renal transplantation decreases exponentially over time, most occurring in the first 90 days and is not predicted by any of the traditional risk factors or drug therapies. (2) However, a clinical decision leading to a stress test or coronary angiography and stress test positivity are highly predictive of a higher MACE rate.
- © 2011 by American Heart Association, Inc.