Table 1.

Recent descriptions of the outcome implications of angiographic coronary artery disease in ESRD patients including transplant candidates

Reference	Participants and Design	Selection Criteria for Angiography	Angiographic Definition of CAD	Estimated CAD Prevalence	Associations of CAD with Clinical Events
De Lima et al, 200316	106 patients presenting for transplant evaluation at one center, deemed at moderate or high coronary risk (1998–2002). Prospective	Moderate-risk: Age ≥50 years High-risk: History of diabetes, MI, angina, stroke, LV dysfunction, peripheral vascular disease. Willing to consent	≥70% Stenosis in one or more epicardial arteries by visual estimation. Evaluation by 2 observers	CAD present in 42% (44/106) 1, 2, 3 vessel disease in 19%, 16%, and 7% of the sample, respectively	MACE, defined as: sudden death, MI, arrhythmia, heart failure, unstable angina, revascularization Unadjusted probability of reaching endpoint at 1,2 and 4 years was higher with angiographic CAD (P<0.001): 13%, 39%, 46% versus 2%, 6%, 6% in absence of CAD
Sharma, et al, 200515	125 consecutive patients referred for renal transplant evaluation.	Age >18 years Free of severe aortic stenosis, unstable angina Willing to consent	Severity by degree of luminal narrowing: Mild, <50%; Moderate, 50–70%; Severe, >70% Evaluation by 2 observers	CAD present in 64% (80/125) Severe, moderate and mild in 29%, 14% and 21% of the sample	Unadjusted survival at two-years was significantly lower among those with compared to without CAD (85% versus 100%, P=0.005)
Charytan et al, 200717	67 prevalent hemodialysis patients (1998), subset of a larger study (n=224) Prospective	Free of ischemic symptoms at enrollment Free of coronary events within 4 weeks No coronary angiography within prior 2 yrs Willing to consent	>50% Narrowing compared to adjacent normal segment by digital calipers Evaluation by 2 observers	CAD in 42% (28/67), including involvement of proximal third of an epicardial vessel in 28.5% Of 28 subjects with CAD, 75% had multivessel and 68% had proximal lesions	Over median 2.7 years observation, the presence of any CAD was associated with increased risk of death Only proximal CAD was associated with mortality in adjusted analyses (aHR 3.14, 95% CI 1.34–7.33)
Gowdak, et al, 200718	301 patients referred for transplant evaluation and deemed at high coronary risk	Inclusion criteria: History of diabetes, prior cardiovascular disease (MI, unstable angina, stroke, left ventricular dysfunction, or extracardiac atherosclerosis), or age >50 years Willing to consent	≥70% luminal reduction in one or more epicardial arteries Evaluation by 2 observers	Significant CAD in 45% (136/301)	MACE, defined as: MI, unstable angina, sudden death, unplanned coronary or peripheral arterial revascularization, stroke, or heart failure Over median 1.8 years observation, crude incidence of MACE was higher in those with CAD (45% vs 18%, P<0.001)
Gowdak, et al, 200719	288 patients referred for transplant evaluation. Portion of the cohort in18	High clinical risk, as defined in18	≥70% luminal reduction in one or more epicardial arteries Evaluation by 2 observers	Significant CAD in 43% (124/288)	MACE as defined in 18 CAD was associated with significantly higher crude relative risk of MACE among non-diabetic patients (HR 4.3, 95% CI 2.4–7.9, P<0.001) No significant association of CAD with MACE in diabetic patients
Hage et al, 200720	260 patients studied by angiography from a cohort of 3698 referred for transplant evaluation at one center (2001–2004). Retrospective	Positive stress myocardial perfusion imaging, known CAD, or discretion of Cardiologist	>50% lumen diameter narrowing in any of 3 major coronary arteries or major branches. Left- main considered equivalent to 2-vessel disease Results obtained from clinical reports	CAD in 62% (162/260) 1, 2, 3 vessel disease in 16%, 13%, and 33% of the sample submitted to angiography, respectively 36% (94/260) of the angiography group underwent revascularization	Presence and severity of CAD was not associated with crude survival among those who underwent angiography: 2-year survival 80%, 88%, 86% and 78% for 0, 1, 2, 3-vessel disease (P=0.6)
Patel et al, 200821	99 patients studied by angiography from a cohort of 300 referred for KT evaluation at one center (2002–2005). Retrospective	Angiography suggested if: Age >50 yrs, ESRD due to diabetes, symptomatic ischemic heart disease, or positive non-invasive testing Final selection based on clinical judgment and patient preference	Obstructive, >75% Non-obstructive, Stenosis present but ≤75%	CAD in 57.6% (57/99) Obstructive in 34.3% (34/99), including 1-, 2-, and 3-vessel disease in 13%, 15%, and 6% of the sample, respectively Non-obstructive in 23.2% (23/99) 17% (17/99) of the angiography group underwent revascularization	No difference in crude four-year survival in patients found to have CAD and revascularized, compared to those who underwent angiography without revascularization, or those not studied by angiography (P=0.7).
Hickson, et al, 200822	134 patients studied by angiography from a cohort of 644 referred for KT evaluation at one center (2004–2006) Retrospective	Angiography performed if dobutamine stress echo was positive Cardiologist recommended	Severity by highest degree of stenosis of single major epidcaridal arteries: Mild, <50%; Moderate, 50–70%; Severe, >70% %	CAD present in 81% (119/131) of those studied by angiography Severe, moderate and mild in 56%, 20% and 25% of the angiography sample 6.2% (40/644) of the full cohort underwent revascularization before listing	Over median 6 months observation, the severity of CAD by angiography was not significantly associated with mortality in the full cohort (P=0.2)

aHR, adjusted hazards ratio; CAD, coronary artery disease; CI, confidence interval; KT, kidney transplant; MACE, major adverse cardiovascular events; MI, myocardial infarction