In a real-life setting, risk factors, coronary artery calcium score, and coronary stenosis at computed tomography angiography are associated with major adverse cardiovascular events and all-cause mortality among kidney transplant candidates

Marie Bodilsen Nielsen; Jonathan Nørtoft Dahl; Rasmus Laursen; Bente Jespersen; Per Ivarsen; Simon Winther; Henrik Birn

doi:10.1016/j.ajt.2023.05.001

In a real-life setting, risk factors, coronary artery calcium score, and coronary stenosis at computed tomography angiography are associated with major adverse cardiovascular events and all-cause mortality among kidney transplant candidates

Am J Transplant. 2023 Aug;23(8):1194-1208. doi: 10.1016/j.ajt.2023.05.001. Epub 2023 May 10.

Authors

Marie Bodilsen Nielsen¹, Jonathan Nørtoft Dahl², Rasmus Laursen³, Bente Jespersen⁴, Per Ivarsen⁴, Simon Winther⁵, Henrik Birn⁶

Affiliations

¹ Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark. Electronic address: marie.bodilsen@biomed.au.dk.
² Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
³ Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark.
⁴ Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
⁵ Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
⁶ Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.

PMID: 37172693
DOI: 10.1016/j.ajt.2023.05.001

Abstract

Kidney failure is associated with an increased risk of cardiovascular disease and death. This single-center, a retrospective study evaluated the association between risk factors, coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), major adverse cardiovascular events (MACEs), and all-cause mortality in kidney transplant candidates. Data on clinical risk factors, MACE, and all-cause mortality were collected from patient records. A total of 529 kidney transplant candidates were included (median follow-up of 4.7 years). CACS was evaluated in 437 patients and CTA in 411. Both the presence of ≥3 risk factors, CACS of ≥400, as well as multiple-vessel stenoses or left main artery disease predicted MACE (hazard ratio, 2.09; [95% confidence interval, 1.35-3.23]; 4.65 [2.20-9.82]; 3.70 [1.81-7.57]; 4.90 [2.40-10.01]) and all-cause mortality (harad ratio, 4.44; [95% confidence interval, 2.54-7.76]; 4.47 [2.22-9.02]; 2.82 [1.34-5.94]; 5.41 [2.81-10.41]) in univariate analyses. Among patients eligible for CACS and CTA (n = 376), only CACS and CTA were associated with both MACE and all-cause mortality. In conclusion, risk factors, CACS, and CTA provide information on the risk of MACE and mortality in kidney transplant candidates. An additional value of CACS and CTA compared with risk factors was observed for the prediction of MACE in a subpopulation undergoing both CACS and CTA.

Keywords: cardiovascular disease; computed tomography angiography; kidney transplantation; mortality.