Elsevier

The Lancet

Volume 340, Issue 8826, 24 October 1992, Pages 998-1002
The Lancet

ORIGINAL ARTICLES
Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure

https://doi.org/10.1016/0140-6736(92)93010-KGet rights and content

Abstract

Insulin-dependent diabetic patients found to have substantial coronary artery disease at the time of assessment for renal transplantation have 2-year survival of less than 50%. Because most of these patients have no angina symptoms their management is controversial. We tried to find out whether coronary artery revascularisation in such patients might decrease the combined incidence of unstable angina, myocardial infarction, and cardiac death.

151 consecutive insulin-dependent diabetic candidates for renal transplantation underwent coronary angiography. 31 had stenoses greater than 75% in one or more coronary arteries, atypical chest pain or no chest pain, and a left ventricular ejection fraction greater than 0·35. Of these, 26 agreed to be randomly assigned medical treatment (a calcium-channel-blocking drug plus aspirin) or revascularisation (angioplasty or coronary bypass surgery). 10 of 13 medically managed and 2 of 13 revascularised patients had a cardiovascular endpoint within a median of 8·4 months of coronary angiography (p<0·01). 4 medically managed patients died of myocardial infarction during follow-up.

Thus, revascularisation decreased the frequency of cardiac events in insulin-dependent diabetic patients with chronic renal failure and symptomless coronary artery stenoses. These findings suggest that diabetic renal transplant candidates should be screened for silent coronary artery disease, because revascularisation may decrease cardiac morbidity and mortality in this population.

References (22)

There are more references available in the full text version of this article.

Cited by (315)

  • Outcomes of Interventional Management of Coronary Artery Disease in Kidney Transplant Recipients

    2022, Transplantation Proceedings
    Citation Excerpt :

    There was no difference noted in mortality in patients receiving dialysis [21]. In another smaller randomized trial specifically among patients with ESRD and diabetes with asymptomatic CAD, the group that was revascularized had markedly superior outcomes compared with those only managed medically [22]. Although these studies offer some support that patients with ESRD may benefit from early revascularization, it is difficult to generalize to our population.

  • Kidney Transplant List Status and Outcomes in the ISCHEMIA-CKD Trial

    2021, Journal of the American College of Cardiology
    Citation Excerpt :

    We believe the findings of the present study and those of the overall ISCHEMIA-CKD trial should prompt a re-examination of the current clinical practice of preemptive noninvasive assessment and coronary revascularization of potential kidney transplant recipients with chronic coronary disease, particularly those with asymptomatic myocardial ischemia and those without left main CAD. The results of this analysis differ from the prior, smaller study of Manske et al (1) that set the foundation for pre-emptive revascularization among potential kidney transplant recipients with stable CAD. In the present study and the overall ISCHEMIA-CKD trial, the invasive and conservative strategies were equally efficacious; however, a crucial feature of the trial was the implementation of optimal medical therapy in both groups, including intensive treatment of dyslipidemia, with high treatment goal achievement (7).

View all citing articles on Scopus
View full text