Patients with end-stage renal disease (ESRD) and coronary artery disease (CAD) have an elevated risk of adverse cardiovascular events, which is increased in patients undergoing renal transplant in the peri- and post-operative period. High-risk patients are often referred for cardiac catheterization for preoperative risk assessment. To mitigate risk of potential adverse cardiac events, patients may undergo percutaneous coronary intervention (PCI) for stable CAD. However, little evidence supports this practice. We identified 237 patients who received preoperative catheterization and subsequent renal transplant at the University of Pennsylvania between 2003-2015 to determine the incidence of death, myocardial infarction, stroke, and bleeding. We hypothesized that in patients with ESRD and CAD undergoing cardiac catheterization for risk stratification prior to renal transplant, there would be no difference in adverse events, regardless of CAD burden or PCI. Patients were categorized based on the degree of stenosis and whether PCI was performed: Group 1 (n = 106) with <50% stenosis, Group 2 (n = 75) with ≥50% stenosis without PCI performed, and Group 3 (n = 56) with ≥50% stenosis with PCI performed. The average time from catheterization to transplant was 2.35 ± 2.44 years. Outcomes were measured over an average follow up time of 5.3 ± 2.43 years.
Results: Group 3 had more severe CAD burden compared to Group 2, with significantly more proximal right coronary lesions (17% vs 5%, p <0.05), left anterior descending lesions (89% vs 72%, p <0.05), vein-graft lesions (11% vs 3%, p <0.05), fewer non-occluded vessels (72% vs 87%, p <0.05), greater number of lesions (121 vs 107, p <0.05), and tighter average stenosis (81% vs 66%, p <0.001). Group 3 trended towards fewer deaths (1.8% vs 4.0%, p=0.47), fewer strokes (0% vs 4.0%, p=0.17), fewer bleeding events (14% vs 27%, p=0.09), and more myocardial infarctions (5.4% vs 4.0%, p=0.70) compared to Group 2. These did not reach statistical significance. In conclusion, despite more severe CAD, there was a trend towards improved outcomes in death, stroke, and bleeding in the group that underwent PCI for ≥50% stenosis. Further trials are needed to validate this hypothesis-generating study.