Effects of Coronary Revascularization for Patients With CAD Awaiting Renal Transplant

A systematic review and meta-analysis found that coronary revascularization was not superior to optimal medical therapy among patients with coronary artery disease (CAD) who were waitlisted for kidney transplant. These findings were published in the Journal of the American Heart Association.

Researchers from the Thomas Jefferson University Hospital searched publication databases through June 2021 for studies of CAD treatment among patients awaiting kidney transplant. A total of 8 studies met the inclusion criteria.

This analysis comprised data from 945 patients, 35.9% of whom were women. Patients who underwent revascularization were aged mean 56.5 years and those who received optimal medical therapy were aged mean 56.1 years.

At an average follow-up of 3.1 years, revascularization was not associated with decreased risk for all-cause mortality (risk ratio [RR], 1.16; 95% CI, 0.63-2.12; P =.63; I², 68%), cardiovascular mortality (RR, 0.75; 95% CI, 0.29-1.89; P =.54; I², 35%), or major adverse cardiovascular events (MACE; RR, 0.78; 95% CI, 0.30-2.07; P =.62; I², 67%).

In a sensitivity analysis using data from 2 studies that were unadjusted, revascularization was favored for reducing MACE (RR, 0.07; 95% CI, 0.01-0.55; P =.01; I², 0%). Neither the analysis which considered data from the 4 adjusted studies (RR, 1.23; 95% CI, 0.53-2.88; P =.63; I², 62%) nor the pooled analysis (RR, 0.78; 95% CI, 0.30-2.07; P =.62; I², 67%) confirmed these findings. In addition, the pooled analysis found significant subgroup variation (c², 6.39; P =.01).

This study was limited by the baseline heterogeneity among study populations and the short follow-up duration. Additional study would be needed to assess long-term outcomes.

This study found no evidence to support revascularization over optimal medical therapy among patients with CAD awaiting renal transplant. As no protocols have been established for CAD therapy among this patient population, further research is needed to establish evidence-based guidelines for effective CAD interventions. “Therefore, initiating aggressive [optimal medical therapy] and conducting vigorous cardiac risk stratification primarily to exclude left main disease, with close hemodynamic monitoring perioperatively, are essential for optimizing outcomes in this high-risk population,” the study authors wrote.

Reference

Siddiqui MU, Junarta J, Marhefka GD. Coronary revascularization versus optimal medical therapy in renal transplant candidates with coronary artery disease: A systematic review and meta-analysis. J Am Heart Assoc. Published online February 8, 2022. doi:10.1161/JAHA.121.023548