Document Type

Article

Publication Date

2-15-2022

Comments

This article is the author’s final published version in Journal of the American Heart Association, Volume 11, Issue 4, February 2022, Pages e023548

The published version is available at https://doi.org/10.1161/JAHA.121.023548. Copyright © Siddiqui, Junarta, and Marhefka.

Abstract

Background Coronary artery disease (CAD) is highly prevalent in patients with chronic kidney disease and is a common cause of mortality in end-stage renal disease. Thus, patients with end-stage renal disease are routinely screened for CAD before renal transplantation. The usefulness of revascularization before transplantation remains unclear. We hypothesize that there is no difference in all-cause and cardiovascular mortality in waitlisted renal transplant candidates with CAD who underwent revascularization versus those treated with optimal medical therapy before transplantation. Methods and Results This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the modified Newcastle-Ottawa Scale and Cochrane risk of bias tool. The primary outcome of interest was all-cause mortality. Eight studies comprising 945 patients were included (36% women, mean age 56 years). There was no difference in all-cause mortality (risk ratio [RR], 1.16 [95% CI, 0.63-2.12), cardiovascular mortality (RR, 0.75 [95% CI, 0.29-1.89]), or major adverse cardiovascular events (RR, 0.78 [95% CI, 0.30-2.07]) when comparing renal transplant candidates with CAD who underwent revascularization versus those who were on optimal medical therapy before renal transplant. Conclusions This meta-analysis demonstrates that revascularization is not superior to optimal medical therapy in reducing all-cause mortality, cardiovascular mortality, or major adverse cardiovascular events in waitlisted kidney transplant candidates with CAD who eventually underwent kidney transplantation.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

35132876

Language

English

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