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. 2013 Nov;26(11):1080-7.
doi: 10.1111/tri.12168. Epub 2013 Aug 20.

Multivessel coronary revascularization and outcomes in kidney transplant recipients

Colin R Lenihan  1 , Maria E Montez-Rath, Wolfgang C Winkelmayer, Tara I Chang
Affiliations

Multivessel coronary revascularization and outcomes in kidney transplant recipients

Colin R Lenihan et al. Transpl Int. 2013 Nov.

Abstract

Coronary artery disease is a major cause of morbidity and mortality in the kidney transplant population. We compared the long-term outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary intervention (PCI) for multivessel coronary disease in a contemporary cohort of US kidney transplant recipients. From the U.S. Renal Data System, we identified all adult kidney transplant patients with ≥6 months of Medicare A+B undergoing first recorded multivessel coronary revascularization from 1997 to 2009. The associations of CABG versus PCI with death and the composite of death or myocardial infarction (MI) were compared using proportional hazards regression. Of the 2272 patients included in the study, 1594 underwent CABG and 678 underwent PCI. The estimated 5-year survival rate was 55% [95% confidence interval (CI) 53% to 57%] following coronary revascularization, with no significant association between revascularization type and death [adjusted hazard ratio (aHR) = 1.08; CI 0.94-1.23] or the composite of death or MI (aHR = 1.07; CI 0.96-1.18). Separate propensity score-matched analyses yielded similar results. In this analysis of kidney transplant recipients undergoing multivessel coronary revascularization, we found no difference between CABG and PCI in terms of survival or the composite of death and MI.

Keywords: coronary artery bypass graft; coronary artery disease; kidney transplant; percutaneous coronary intervention.

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Conflict of interest statement

Disclosures: The authors of this manuscript have no conflicts of interest to disclose as described by Transplant International.

Figures

Figure 1
Figure 1
Cohort assembly of patients with functioning kidney transplant at the time of first recorded multivessel coronary revascularization.
Figure 2
Figure 2
Distribution of revascularization method by index year Abbreviations: Unk = unknown; DES = drug eluting stent; BMS = bare metal stent; CABG = coronary artery bypass grafting
Figure 3
Figure 3
Survival curves for the propensity score-matched cohort for (A) death and (B) the composite of death or MI. Log-rank tests yielded p=0.48 for the outcome of death (A) and p=0.79 for the outcome of death or MI (B).
Figure 4
Figure 4
Unadjusted and adjusted hazard ratios for coronary artery bypass grafting compared with percutaneous coronary intervention (referent).for the outcomes of (A) death or (B) death or myocardial infarction Model 1: Adjusted for age, sex, race Model 2: Model 1 + adjustment for cause of ESRD, total years with ESRD, years with current transplant, transplant type, preemptive current transplant, previous failed transplant, skilled nursing facility utilization, hospital days, non-nephrology clinic visits, index myocardial infarction, and comorbid conditions: myocardial infarction, cerebrovascular disease valve disease, heart failure, peripheral vascular disease, diabetes mellitus, hypertension, alcohol, tobacco, cancer, chronic pulmonary disease Model 3: Propensity score-matched cohort
See this image and copyright information in PMC

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