Review article: Coronary artery stenoses: detection and revascularization in renal disease.
Cardiovascular events are markedly elevated in those with all degrees of renal impairment compared to the general population. There are well established guidelines in the general population for the management of coronary artery disease, however, similar guidelines have not been established in the renal population. This review examines the current published work on the detection of coronary artery stenoses in addition to summarizing the outcomes of revascularization in patients with kidney disease. Testing for coronary artery disease in the renal population most commonly occurs in dialysis patients as part of their assessment for renal transplantation. While a positive myocardial stress test for the detection of significant coronary artery stenoses is associated with an increased risk of cardiac events, there is no clear information currently showing that cardiovascular testing itself reduces the rate of adverse cardiac events after transplantation. Revascularization of coronary artery stenoses is associated with higher morbidity and mortality in all groups with kidney disease than in the general population, with the exception of renal transplant recipients where the mortality is likely to be similar to that of the general population. There appears to be a benefit in coronary artery bypass surgery compared to percutaneous intervention in those on dialysis and after renal transplant. Currently, there is little data to support coronary artery intervention prior to transplantation in those with asymptomatic coronary artery disease.
Pilmore
Helen L
HL
Department of Renal Medicine, Auckland Hospital, Auckland, New Zealand. hpilmore@adhb.govt.nz
D002908:Chronic Disease; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D016030:Kidney Transplantation; D009204:Myocardial Revascularization; D006435:Renal Dialysis