title: Is standardized cardiac assessment of asymptomatic high-risk renal transplant candidates beneficial?
abstract: BACKGROUND
  Perioperative cardiovascular events in renal transplantation are common and non-invasive cardiac stress tests are recommended in high-risk renal transplant candidates. In 2004, we introduced a standardized preoperative cardiac risk assessment programme with the aim of reducing perioperative cardiac events.
  
  
  METHODS
  Since 2004, all asymptomatic high-risk renal transplant candidates had to undergo non-invasive cardiac stress testing. Patients with a positive stress test went for a coronary angiography and if indicated for revascularization. The incidence of perioperative cardiac events (≤30 days of transplantation) was analysed in all high-risk patients who received a transplantation (screening group) and compared with high-risk renal transplant recipients evaluated in the 4 years before the introduction of the cardiac assessment programme (historical control group).
  
  
  RESULTS
  Since 2004, 227 of 349 asymptomatic high-risk renal transplant candidates underwent non-invasive cardiac stress testing. In 15 patients (6.6%), significant ischaemia was found. Ten of these 15 patients underwent coronary angiography (eight patients had significant coronary artery disease and in five patients, percutaneous coronary intervention was performed). One hundred and sixty of 349 renal transplant candidates have received renal transplantation so far (screening group). In the screening group, 6 perioperative cardiac events (3.8%) occurred compared to 13 perioperative events (7.6%) in the historical control group (n = 172) (P = 0.136).
  
  
  CONCLUSIONS
  The incidence of significant cardiac ischaemia in high-risk renal transplant patients was low and was followed by revascularization in a small percentage of patients. No significant decrease in perioperative cardiac events was observed after the introduction of the standardized cardiac assessment programme.
authors.affiliation: Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.aalten@nier.umcn.nl
authors.forename: Jeroen
authors.initials: J
authors.lastname: Aalten
authors.forename: Stijn A
authors.initials: SA
authors.lastname: Peeters
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: van der Vlugt
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000592:standards*; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate