title: Influence of coronary artery disease assessment and treatment in the incidence of cardiac events in renal transplant recipients.
abstract: BACKGROUND
  The best strategy for pre-transplant investigation and treatment of coronary artery disease (CAD) is controversial.
  
  
  METHODS
  We evaluated 167 renal transplant recipients before transplantation to determine the incidence of cardiac events and death. We performed clinical evaluations and myocardial scans in all patients and coronary angiography in select patients.
  
  
  RESULTS
  Asymptomatic patients with normal myocardial scans (n=57) had significantly fewer cardiac events (log-rank=0.0002) and deaths (log-rank=0.0005) than did patients with abnormal scans but no angiographic evidence of CAD (n=76) and individuals with CAD (n=34) documented angiographically. CAD increased the probability of events (HR=2.27, % CI 1.007-5.11; p=0.04). The incidence of cardiac events (log-rank=0.349) and deaths (log-rank=0.588) was similar among patients treated medically (n=23) or by intervention (n=11).
  
  
  CONCLUSIONS
  Asymptomatic patients with normal myocardial scans had a better cardiac prognosis than did patients with or without CAD and positive for myocardial ischemia. Patients with altered scan and CAD had the poorer outcome. Guideline-oriented medical treatment is safe and yields results comparable to coronary intervention in renal transplant patients with CAD. The data do not support preemptive myocardial revascularization for renal transplant candidates.
authors.affiliation: Heart Institute (InCor), Renal Transplant Unit, Urology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. jose.lima@incor.usp.br
authors.forename: José J G
authors.initials: JJ
authors.lastname: De Lima
authors.forename: Luis H W
authors.initials: LH
authors.lastname: Gowdak
authors.forename: Flavio J
authors.initials: FJ
authors.lastname: de Paula
authors.forename: Rodolfo L
authors.initials: RL
authors.lastname: Arantes
authors.forename: Luis E
authors.initials: LE
authors.lastname: Ianhez
authors.forename: Jose A F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Krieger
mesh_terms: D009202:Cardiomyopathies / Q000453:epidemiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome