title: Role of Coronary Angiography in the Assessment of Cardiovascular Risk in Kidney Transplant Candidates.
abstract: Cardiovascular disease is the leading cause of death among those with renal insufficiency, those requiring dialysis, and in recipients of kidney transplants reflecting the greatly increased cardiovascular burden that these patients carry. The best method by which to assess cardiovascular risk in such patients is not well established. In the present study, 1,225 patients seeking a kidney transplant, over a 30-month period, underwent cardiovascular evaluation. Two hundred twenty-five patients, who met selected criteria, underwent coronary angiography that revealed significant coronary artery disease (CAD) in 47%. Those found to have significant disease underwent revascularization. Among the patients found to have significant CAD, 74% had undergone a nuclear stress test before angiography and 65% of these stress tests were negative for ischemia. The positive predictive value of a nuclear stress test in this patient population was 0.43 and the negative predictive value was 0.47. During a 30-month period, 28 patients who underwent coronary angiography received an allograft. None of these patients died, experienced a myocardial infarction, or lost their allograft. The annual mortality rate of those who remained on the waiting list was well below the national average. In conclusion, our results indicate that, in renal failure patients, noninvasive testing fails to detect the majority of significant CAD, that selected criteria may identify patients with a high likelihood of CAD, and that revascularization reduces mortality both for those on the waiting list and for those who receive an allograft.
authors.affiliation: Department of Neurosurgery, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: David M
authors.initials: DM
authors.lastname: Mann
authors.affiliation: Division of Nephrology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Sonalis
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: Division of Nephrology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Zahidul
authors.initials: Z
authors.lastname: Mondal
authors.affiliation: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: David
authors.initials: D
authors.lastname: Laskow
authors.affiliation: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Adena
authors.initials: A
authors.lastname: Osband
authors.affiliation: Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Meelie
authors.initials: M
authors.lastname: Debroy
authors.affiliation: Division of Nephrology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lebowitz
authors.affiliation: Division of Cardiology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: James
authors.initials: J
authors.lastname: Coromilas
authors.affiliation: Division of Cardiology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Tudor
authors.initials: T
authors.lastname: Vagaonescu
authors.affiliation: Division of Cardiology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Abel
authors.initials: A
authors.lastname: Moreyra
authors.affiliation: Kidney/Pancreas Transplant Program, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Melita
authors.affiliation: Division of Nephrology, Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address: mannri@rwjms.rutgers.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mann
mesh_terms: D000368:Aged; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005080:Exercise Test; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014850:Waiting Lists