Long-term outcome after coronary angioplasty in renal transplant and hemodialysis patients.
In order to determine how renal transplantation modifies in hospital and long-term outcome after coronary angioplasty, we compared dialysis and renal transplant patients with control patients without renal failure. Seventy-five consecutive dialysis patients (group D) and 37 renal transplant patients (group T) undergoing coronary angioplasty, were compared with two control groups (groups control D and control T, respectively) matched 1:1 with groups D and T for clinical and angiographic characteristics. The mean follow-up was 50 months. The rate of angiographic success was high and comparable in the four groups (P=0.7). Renal transplant patients were younger than dialysis non-transplant patients (P=0.004). The risk of 4-year cardiac death and nonfatal myocardial infarction was higher in dialysis compared to control dialysis patients (OR 2.6, 95% CI 1.35--5.01, P=0.004), in transplant patients compared to control transplant patients (OR 9.93, 95% CI 1.17--84.04, P=0.03), and there was a trend toward a higher risk in dialysis than in renal transplant patients (OR 1.6, 95% CI 0.8--3.19, P=0.08). The risk of 4-year mortality was higher in dialysis patients than in the other three groups (31% in group D versus 19% in group T, 13% in group control D, and 0% in group control T, P<0.001). After adjusting for age, diabetes, and multivessel disease, long-term mortality risk was similar in dialysis and renal transplant patients. On multivariate analysis, renal function (P=0.002), age (P=0.005), and tobacco consumption (P=0.005) were independently associated with 4-year cardiac death. In patients with end-stage renal disease who undergo coronary angioplasty, renal transplantation was not independently associated with a lower long-term mortality compared to dialysis treatment. Both dialysis and renal transplant patients show lower survival rates compared to matched control patients.
Borentain
Maria
M
Département de Cardiologie Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Le Feuvre
Claude
C
Helft
Gérard
G
Beygui
Farzin
F
Batisse
Jean Paul
JP
Drobinski
Gérard
G
Metzger
Jean Philippe
JP
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D016022:Case-Control Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome