Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates

David M. Mann, Sonalis Fernandez, Zahidul Mondal, David Laskow, Adena Osband, Meelie Debroy, Jonathan Lebowitz, James Coromilas, Tudor Vagaonescu, Abel Moreyra, Elizabeth A. Melita, Richard A. Mann

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6 Scopus citations

Abstract

Cardiovascular disease is the leading cause of death among those with renal insufficiency, those requiring dialysis, and in recipients of kidney transplants reflecting the greatly increased cardiovascular burden that these patients carry. The best method by which to assess cardiovascular risk in such patients is not well established. In the present study, 1,225 patients seeking a kidney transplant, over a 30-month period, underwent cardiovascular evaluation. Two hundred twenty-five patients, who met selected criteria, underwent coronary angiography that revealed significant coronary artery disease (CAD) in 47%. Those found to have significant disease underwent revascularization. Among the patients found to have significant CAD, 74% had undergone a nuclear stress test before angiography and 65% of these stress tests were negative for ischemia. The positive predictive value of a nuclear stress test in this patient population was 0.43 and the negative predictive value was 0.47. During a 30-month period, 28 patients who underwent coronary angiography received an allograft. None of these patients died, experienced a myocardial infarction, or lost their allograft. The annual mortality rate of those who remained on the waiting list was well below the national average. In conclusion, our results indicate that, in renal failure patients, noninvasive testing fails to detect the majority of significant CAD, that selected criteria may identify patients with a high likelihood of CAD, and that revascularization reduces mortality both for those on the waiting list and for those who receive an allograft.

Original languageEnglish (US)
Pages (from-to)679-683
Number of pages5
JournalAmerican Journal of Cardiology
Volume118
Issue number5
DOIs
Publication statusPublished - 2016

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mann, D. M., Fernandez, S., Mondal, Z., Laskow, D., Osband, A., Debroy, M., ... Mann, R. A. (2016). Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates. American Journal of Cardiology, 118(5), 679-683. https://doi.org/10.1016/j.amjcard.2016.06.017