Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention

Wayne C Zheng; Nicole Evans; Diem Dinh; Jason E Bloom; Angela L Brennan; Jocasta Ball; Jeffrey Lefkovits; James A Shaw; Christopher M Reid; William Chan; Dion Stub

doi:10.1016/j.hlc.2024.01.033

Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention

Heart Lung Circ. 2024 Apr 1:S1443-9506(24)00073-8. doi: 10.1016/j.hlc.2024.01.033. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Alfred Health, Melbourne, Vic, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
³ Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.
⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Population Health, Curtin University, Perth, WA, Australia.
⁷ Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia.
⁸ Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia. Electronic address: dion.stub@monash.edu.

PMID: 38565437
DOI: 10.1016/j.hlc.2024.01.033

Abstract

Background: Clinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated.

Method: Between 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m²) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)-composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke.

Results: RT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality.

Conclusions: RT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.

Keywords: Chronic kidney disease; Dialysis; Outcomes; Percutaneous coronary intervention; Renal transplant.

Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.