HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Nimmo A, Taylor DM, Ravanan R

Does Screening for Coronary Artery Disease Predict Cardiac Outcomes Following Renal Transplantation?

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:57A 2020

BACKGROUND

Screening for asymptomatic coronary artery disease (CAD) prior to transplantation aims to reduce perioperative cardiac events. There is conflicting evidence as to whether this is achieved.

METHODS

Individuals recruited to the Access to Transplant and Transplant Outcome Measures (ATTOM) study in England who received a renal transplant between 2011-2017 were studied. Patient demographics and details of screening investigations from ATTOM were linked to outcome data from the Hospital Episode Statistics dataset.

Major Adverse Cardiac Events (MACE) comprised unstable angina, myocardial infarction, coronary bypass graft, coronary angioplasty or cardiac death. The effect of screening on MACE was analysed in propensity score-matched groups, using Cox survival analyses, up to 5 years post- transplant.

RESULTS

2572 individuals received a renal transplant; 51% underwent CAD screening (Figure 1). Age, ethnicity, ischaemic heart disease and diabetes were independently associated with screening. The incidence of MACE at 90 days, 1 and 5 years was 0.9%, 2.1% and 9.4%.

After propensity score matching, 1854 individuals were examined. There was no association between screening and MACE at 90 days (HR 0.68, 95% CI 0.28- 1.64), 1 year (HR 1.24, 95% CI 0.60–2.54) or 5 years (HR 1.31, 95% CI 0.95–1.79) (Figure 2).

CONCLUSION

Screening for CAD did not influence the rate of ischaemic cardiac events up to 5 years post- transplant. Units should review protocols with lengthy cardiac workup processes.


Factors associated with MACE following propensity score matching

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