Presentation focused on pre-operative evaluation of Major Adverse Cardiac Events prior to renal transplantation.
Modified from a presentation I gave in 2007; compared to the original there is a less enthusiastic endorsement of a peri-operative fixed dose beta blockade administration strategy given the discrepant results of the POISE and DECREASE-II studies
28. Risk Factors for MACEs in High – Risk Vascular Procedures IIa JAMA. 2001;285:1865-1873
29. Risk Factors for MACEs in High – Risk Vascular Procedures IIb JAMA. 2001;285:1865-1873
30. Risk Factors for MACEs in High – Risk Vascular Procedures IIc JAMA. 2001;285:1865-1873
31. Risk Factors for MACEs in High – Risk Vascular Procedures IIIa JAMA. 2001;285:1865-1873
32. Risk Factors for MACEs in High – Risk Vascular Procedures IIIb JAMA. 2001;285:1865-1873
33.
34. Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation: A Meta-Analysis
35. Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation: A Meta-Analysis
36. Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation: A Meta-Analysis Did these events occur before, immediately after, a long time after the transplant, or on dialysis, the cath table or a CTICU ? Toss a dice – they never told us
37.
38. Prognostic Value of Myocardial Perfusion Imaging in Predicting Outcome After Renal Transplantation DM, known CAD, multiple clinical RFs
39.
40. Prognostic Value of Myocardial Perfusion Imaging in Predicting Outcome After Renal Transplantation Similar to previous studies, no conclusion could be drawn apropos early perioperative MACEs
41.
42.
43.
44.
45.
46. Coronary Angiography Is the Best Predictor of Events in Renal T ransplant Candidates Compared With Noninvasive Testing
47. Is Coronary Angiography a much better p redictor of Events in Renal T ransplant Candidates when c ompared to Clinical Risk Stratification ?
48.
49.
50. Routine Coronary Angiography in Diabetic N ephropathy Patients Before Transplantation 6% of predialytic patients required dialysis after they had their coronary angiogram !! SAFETY WARNING !
51.
52.
53.
54.
55.
56. Derivation and validation of a disease-specific risk score for cardiac r isk stratification in chronic kidney disease (“Brisbane Score”) Derivation Population Validation Population
57. Derivation and validation of a disease-specific risk score for cardiac r isk stratification in chronic kidney disease (“Brisbane Score”) Validation Population Derivation Population AUC 0.61 0.80 0.58 0.67 AUC 0.60 0.77 0.64 0.67
73. Devereaux, P.J. et al. CMAJ 2005;173:627-634 Potential triggers of states associated with perioperative elevations in troponin levels, arterial thrombosis and fatal myocardial infarction
78. Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery. Poldermans D, Boersma E, et al, “Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery,” NEJM, Vol. 341, No. 24 (1999), pp. 1789-1794.
83. Autopsy Report Question: has revascularization been shown to prevent acute coronary events in stable CAD? Answer: The lesions that rupture are different from the ones that get stented i.e. a full metal jacket strategy is unlikely to work
96. Time for a new conceptual framework? Think not what a stress test can’t do preoperatively, think what you can do for the patient perioperatively.
97.
98.
99.
100. ECG evidence of “high troponin” syndrome or normal variant?
Hinweis der Redaktion
Standard Care: 9/53 (17%) died of cardiac causes in perioperative period and 9/53 (17%) had non-fatal MI. Bisoprolol Group: 2/59 (3.3%) died of cardiac causes in perioperative period and 0/59 (0%) had non-fatal MI. Bisoprolol Group including Data from the 8 excluded: 4/67 (6.0%) died of cardiac causes in perioperative period and 1/67 (1.5%) had non-fatal MI.