Transplant Research and Risk Management (Jul 2020)
Spectrum of Coronary Angiographic Findings in Potential Renal Transplant Recipients in a Tertiary Care Center of Nepal
Abstract
Vijay Yadav, Sunil Chandra Jha, Ratna Mani Gajurel, Chandra Mani Poudel, Ravi Sahi, Manju Sharma, Suman Adhikari Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, NepalCorrespondence: Vijay YadavDepartment of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, NepalTel +977-9851201126Email [email protected]: Studies emphasizing the prevalence of coronary artery disease (CAD) and the diversity of coronary lesions among asymptomatic renal transplant recipients (RTRs) are few and far between in Nepal.Methods: In this cross-sectional observational study, a cohort of potential RTRs who were subjected to coronary angiography (CAG) as a part of both routine pre-op evaluation and therapeutic modality were enrolled and the spectrum of coronary angiographic lesions was reported. Significant CAD was defined by angiography as ≥ 70% stenosis. Percutaneous coronary intervention (PCI) was done for significant lesions.Results: A total of 60 patients (mean age: 53.7 ± 7.2 years, 43 males and 17 females) formed the subjects of the study. Diabetes was the commonest cause of ESRD (61.7%) with the mean duration of ESRD being 4.3 ± 2.2 years. Of the patients, 86.7% were routinely subjected to CAG and the remaining 13.3% presented with acute coronary syndrome. The right femoral artery was the most common access vessel (81.7%). CAD was present in 30/60 patients (50%). The left anterior descending artery was the most common culprit vessel (46.7%), followed by the left circumflex artery (38.3%). Among the routine CAG group, 42.3% had some form of CAD, the highest proportion of which was triple vessel disease (23.3%). Both double vessel disease and triple vessel disease were found to be highly prevalent in patients with hyperlipidemia, diabetes, and in smokers. The angiographic lesions were predominantly of discrete (41%), diffuse (35.9%), and eccentric (46.2%) types, had tandem arrangement (58.9%) with moderate angulation (56.4%), and were irregular (58.9%) in contour. A total of 3 ostial (7.7%) and 9 calcified (23.1%) lesions were found to be present. Chronic total occlusion and bifurcation lesions were observed in 4 (10.3%) and 5 (12.8%) cases, respectively. Six (15.4%) patients had well-developed collaterals. Twenty-one (53.8%) patients underwent PCI and 3 (7.7%) patients underwent coronary artery bypass surgery. Type B2 was the most common lesion (46.2%).Conclusion: Asymptomatic ESRD patients on the renal transplant list were found to have a high prevalence of CAD. CAG can be an efficient screening alternative for the detection of significant CAD among these patients.Keywords: coronary angiography, coronary artery disease, triple vessel disease, end-stage renal disease, kidney transplant
