Abstract 19758: Observational Study of Preoperative Risk Assessment in Renal Transplant Patients Using Serial Myocardial Perfusion Imaging
Background: The utility of periodically screening asymptomatic kidney transplantation candidates for myocardial ischemia, while on the transplant waiting list to reduce the risk of major adverse cardiovascular events (MACE), is uncertain. Among patients awaiting renal transplantation, we examined the likelihood and predictors of change on serial stress myocardial perfusion imaging (SMPI), and in the subset of patients that underwent transplantation, we examined downstream testing and cardiovascular outcomes.
Methods: Consecutive patients undergoing SMPI on the renal transplantation waitlist were identified. The number of SMPI on each patient from 2003-2014 was reviewed. Change on serial MPI was characterized by evidence of new ischemia or infarction. MACE was assessed intraoperatively, within 1 month and at 1 year post-transplant. Coronary angiography and revascularization that occurred between the SMPI and transplant was also documented.
Results: A total of 216 patients underwent SMPI as part of transplant evaluation (60% male; mean age 54±9 years; 83% hypertension, 46% diabetes, 17% prior coronary artery disease- CAD and 12% prior coronary revascularization). Mean time difference between SMPI studies was 2 years (60% >2 SMPI, 16% >5 SMPI) and 46/216 (21%) had change in SMPI. Prior CAD and diabetes were the only predictors of change on SMPI in a multivariable model that also included age and hypertension (chi-square: 43.6; p<0.05). Among the subset of 121 patients that underwent transplantation after SMPI, change in SMPI was noted in 20/121 (16%) in whom pretransplant coronary angiography occurred in 12 patients and revascularization in 7 patients. Diabetes again increased the odds of change in serial MPI (OR 5.5 95% CI: 1.9-15.7, p<0.001) and revascularization in the transplant subset (OR 3.9 95% CI 1.01-15.4, p<0.05). MACE was rare among the transplanted patients- 0 intraoperative, 1 unstable angina at 30-days with diagnosis of triple vessel disease on angiography that had a cardiac death at 1-year.
Conclusions: Change in serial MPI occurs primarily in diabetics and those with known CAD suggesting better yield of SMPI in this subset. Transplant recipients who have been managed based on serial MPI have good 1 year outcomes.
Author Disclosures: A. Madhana kumar: None. S. Prabhakar: None. D.V. Thompson: None. S. Hussain: None. I.G. Poornima: None.
- © 2016 by American Heart Association, Inc.