P010: PREDICTIVE VALUE OF NON-INVASIVE CARDIAC TESTING FOR PREOPERATIVE CORONARY REVASCULARIZATION AND ADVERSE CARDIAC EVENTS 30-DAYS POST KIDNEY TRANSPLANT
Nicholas V Mendez, MD, Raveh Yehuda, MD, Vadim Shatz, MD, Ramona Nicolau-Raducu, MD, PhD; University of Miami Miller School of Medicine
Introduction: Renal transplantation is associated with adverse perioperative cardiovascular outcomes and pretransplant cardiac evaluation is, therefore, indicated for high-risk candidates. The predictive value of non-invasive stress testing for preoperative coronary revascularization, and adverse outcomes in this high risk group is not well established.
Methods: After an IRB approval, out of 313 cadaveric kidneys transplanted between January 2016 to July 2017, we retrospectively identified 52 recipients whose pretransplant cardiac workup included both routine non-invasive stress (regadenoson nuclear 49; dobutamine 2; exercise stress test 1) and coronary angiography (18- due to positive stress test & 34- due to ≥3 risk factors for coronary artery disease). Pretransplant coronary revascularization was required in 33% (17/52; 14 percutaneous and 3 surgical coronary revascularization).
Results: Non-invasive testing had low sensitivity (47%) & positive predictive value (44%), and intermediate specificity (71%) & negative predictive value (74%) for detection of severe coronary artery stenosis (≥ 70%), Table 1. In the first post-transplant month, 11 adverse cardiac events (1 non-fatal and 1 fatal myocardial infarction, 5 atrial fibrillation, 4 pulmonary edema) occurred in 13% (7/52) of recipients. Preoperative non-invasive stress testing and coronary revascularization had an intermediate specificity (64%) and a relatively high negative predictive value (>80%) for prediction of 30-days post kidney transplant adverse cardiac events in high risk recipients, Table 1.
Conclusion: Preoperative revascularization does not fully protect against adverse cardiac outcomes; a positive non-invasive stress test result is not reliably indicative of an increased cardiac risk, but a negative result is strongly predictive of an uneventful posttransplant cardiovascular course.