Long-term outcome of renal transplant recipients in the united states after coronary revascularization procedures

Background - Retrospective studies in dialysis patients have reported increased survival after coronary artery bypass ( CAB) compared with coronary artery stenting and PTCA. The purpose of this study was to compare the long-term outcome of renal transplant recipients after stent, PTCA, or CAB with or without internal mammary grafting ( CAB [IMG+] or CAB [IMG-]). Methods and Results - Renal transplant recipients hospitalized from 1995 to 1999 for first coronary revascularization procedure were retrospectively identified from the United States Renal Data System database. Event-free survival for the end points of all-cause death, cardiac death, acute myocardial infarction ( AMI), and the combined end point of cardiac death or AMI was estimated by the life-table method. The impact of independent predictors on survival was examined in a comorbidity-adjusted Cox model. In-hospital mortality rate was 2.3% for 909 stent patients, 4.3% for 652 PTCA patients, 9.4% for 288 CAB (IMG-) patients, and 5.0% for 812 CAB (IMG+) patients. Two-year all-cause survival (+/-SE) was: stent, 82.5 +/- 2.8%; PTCA, 81.6 +/- 3.1%; CAB (IMG-), 74.4 +/- 5.4%; and CAB (IMG+), 82.7 +/- 2.8%. The relative risks of all-cause and cardiac death were not significantly different among revascularization groups. The relative risk of cardiac death or AMI ( versus PTCA) was 0.90 (95% CI, 0.69 to 1.17) for stent, 0.80 ( 95% CI, 0.55 to 1.17) for CAB (IMG-), and 0.57 ( 95% CI, 0.42 to 0.76) for CAB (IMG+). Conclusions - Renal transplant recipients in the United States have comparable long-term survival after percutaneous and surgical coronary revascularization procedures. The most favorable long-term outcome occurs after surgical coronary revascularization.