Abhinav Goyal1, Kevin Bryan Lo2, Kshitij Chatterjee3, Roy O Mathew4, Peter A McCullough5,6, Sripal Bangalore7, Janani Rangaswami8,9. 1. Department of Digestive Diseases and Transplantation, Einstein Medical Center, Philadelphia, PA, USA. 2. Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA. 3. Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Division of Nephrology, Columbia VA Health Care System, Columbia, SC, USA. 5. Baylor University Medical Center, Dallas, TX, USA. 6. Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Dallas, TX, USA. 7. New York University School of Medicine, New York, NY, USA. 8. Division of Nephrology, Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA. 9. Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA.
Abstract
INTRODUCTION: Chronic kidney disease is an independent risk factor for cardiovascular disease. Despite careful preoperative evaluation, there is a risk of acute coronary syndromes after kidney transplant. METHODS: The National Inpatient Sample for the years 2004-2013 was used for this retrospective cohort study. All adult patients undergoing kidney transplantation were identified using the appropriate ICD-9-CM codes. Multivariate logistic regression was used to identify predictors of acute coronary syndromes in the peri-operative period after kidney transplantation. RESULTS: A total of 147 431 kidney transplants were performed from 2004 through 2013 in the United States. The average peri-operative in-hospital mortality was 0.5%. Acute coronary syndrome occurred in 1.3% patients in the peri-operative period. Half of patients with acute coronary syndromes had pre-existing coronary artery disease. The strongest predictors of acute coronary syndromes included older age: 45-64 years. OR 3.28 95% CI (1.85-5.83), ≥65 years. OR 4.84 (2.59-9.05), race: African American, OR 0.66 (0.47-0.93) and pre-existing coronary artery disease OR 3.83 (2.84-5.15). The case fatality rates were 16.9% and 5.3% for STEMI and NSTEMI, respectively. The overall mortality for any ACS event was 7.1%. CONCLUSION: Acute coronary syndrome in the immediate peri-operative period after kidney transplantation is rare but is associated with high rates of mortality.
INTRODUCTION:Chronic kidney disease is an independent risk factor for cardiovascular disease. Despite careful preoperative evaluation, there is a risk of acute coronary syndromes after kidney transplant. METHODS: The National Inpatient Sample for the years 2004-2013 was used for this retrospective cohort study. All adult patients undergoing kidney transplantation were identified using the appropriate ICD-9-CM codes. Multivariate logistic regression was used to identify predictors of acute coronary syndromes in the peri-operative period after kidney transplantation. RESULTS: A total of 147 431 kidney transplants were performed from 2004 through 2013 in the United States. The average peri-operative in-hospital mortality was 0.5%. Acute coronary syndrome occurred in 1.3% patients in the peri-operative period. Half of patients with acute coronary syndromes had pre-existing coronary artery disease. The strongest predictors of acute coronary syndromes included older age: 45-64 years. OR 3.28 95% CI (1.85-5.83), ≥65 years. OR 4.84 (2.59-9.05), race: African American, OR 0.66 (0.47-0.93) and pre-existing coronary artery disease OR 3.83 (2.84-5.15). The case fatality rates were 16.9% and 5.3% for STEMI and NSTEMI, respectively. The overall mortality for any ACS event was 7.1%. CONCLUSION:Acute coronary syndrome in the immediate peri-operative period after kidney transplantation is rare but is associated with high rates of mortality.