Coronary angiography or revascularization in advanced CKD and CCS does not improve outcomes: Study

Patients with chronic kidney disease (CKD) and coronary artery disease often undergo preemptive revascularization before kidney transplant listing.

A group of researchers from U.S.A. conducted a post hoc analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness of Medical and Invasive Approaches–Chronic Kidney Disease), wherein they compared outcomes of patients not listed versus those listed according to management strategy.

The researchers selected a total of 777 patients, out of which 194 patients (25%) were with chronic coronary syndromes and at least moderate ischemia was listed for transplant. The primary (all-cause mortality or nonfatal myocardial infarction) and secondary (death, nonfatal myocardial infarction, hospitalization for unstable angina, heart failure, resuscitated cardiac arrest, or stroke) outcomes were analyzed using Cox multivariable modeling. Heterogeneity of randomized treatment effect between listed versus not listed groups were assessed.

The results of the study are as follows:

• Compared with those not listed, listed patients were younger (60 years vs 65 years), were less likely to be of Asian race (15% vs 29%), were more likely to be on dialysis (83% vs 44%), had fewer anginal symptoms, and were more likely to have coronary angiography and coronary revascularization irrespective of treatment assignment.
• Among patients assigned to an invasive strategy versus conservative strategy, the adjusted hazard ratios for the primary outcome were 0.91 for those listed and not listed, respectively.
• Adjusted hazard ratios for secondary outcomes were 0.89 in listed and 1.17 in those not listed.

The researchers concluded that in ISCHEMIA-CKD, an invasive strategy in kidney transplant candidates did not improve outcomes compared with conservative management. These data do not support routine coronary angiography or revascularization in patients with advanced CKD and chronic coronary syndromes listed for transplant.

Reference:

Kidney Transplant List Status and Outcomes in the ISCHEMIA-CKD Trial by Herzog C et. al published in the Journal of the American College of Cardiology.

Doi: 10.1016/j.jacc.2021.05.001