title: Risk-stratified cardiovascular screening including angiographic and procedural outcomes of percutaneous coronary interventions in renal transplant candidates.
abstract: Background. Benefits of cardiac screening in kidney transplant candidates (KTC) will be dependent on the availability of effective interventions. We retrospectively evaluated characteristics and outcome of percutaneous coronary interventions (PCI) in KTC selected for revascularization by a cardiac screening approach. Methods. In 267 patients evaluated 2003 to 2006, screening tests performed were reviewed and PCI characteristics correlated with major adverse cardiovascular events (MACE) during a follow-up of 55 months. Results. Stress tests in 154 patients showed ischemia in 28 patients (89% high risk). Of 58 patients with coronary angiography, 38 had significant stenoses and 18 cardiac interventions (6.7% of all). 29 coronary lesions in 17/18 patients were treated by PCI. Angiographic success rate was 93.1%, but procedural success rate was only 86.2%. Long lesions (P = 0.029) and diffuse disease (P = 0.043) were associated with MACE. In high risk patients, cardiac screening did not improve outcome as 21.7% of patients with versus 15.5% of patients without properly performed cardiac screening had MACE (P = 0.319). Conclusion. The moderate procedural success of PCI and poor outcome in long and diffuse coronary lesions underscore the need to define appropriate revascularization strategies in KTC, which will be a prerequisite for cardiac screening to improve outcome in these high-risk patients.
authors.affiliation: Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ; Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Julian
authors.identifier: 0000-0002-6180-2977
authors.initials: J
authors.lastname: König
authors.affiliation: Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ; Division of Emergency Medicine, Charité Campus Virchow-Klinikum and Mitte, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: Department of Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Eda
authors.initials: E
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bocksch
authors.affiliation: Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Seema
authors.identifier: 0000-0001-8192-1079
authors.initials: S
authors.lastname: Baid-Agrawal
authors.affiliation: Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Babel
authors.affiliation: Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schindler
authors.affiliation: Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Campus Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
authors.affiliation: Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Peter
authors.identifier: 0000-0002-0230-1398
authors.initials: P
authors.lastname: Nickel