• Wolff GowdakLuís HenriqueLHHeart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: luis.gowdak@incor.usp.br., José Jayme Galvão De Lima, Eduardo Leal Adam, Isabela Cristina Kirnew Abud Manta, José Otto Reusing, Elias David-Neto, Machado CésarLuiz AntonioLAHeart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil., and Luiz Aparecido Bortolotto.
• Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: luis.gowdak@incor.usp.br.
• Mayo Clin. Proc. 2024 Mar 1; 99 (3): 411423411-423.

ObjectiveTo explore whether, in younger patients on dialysis with longer life expectancy, assessment of coronary artery disease (CAD) could identify individuals at higher risk of events and revascularization might improve outcomes in selected patients contrary to what had been observed in elderly patients.MethodsFrom August 1997 to January 2019, 2265 patients with stage 5 chronic kidney disease were prospectively referred for cardiovascular assessment. For this study, we selected 1374 asymptomatic patients aged between 18 and 64 years. After clinical risk stratification and cardiac scintigraphy by single-photon emission computed tomography, 866 patients underwent coronary angiography. The primary end point was the composite incidence of nonfatal/fatal major adverse cardiovascular events during a follow-up period of 0.1 to 189.7 months (median, 26 months). The secondary end point was all-cause mortality.ResultsThe primary end point occurred in 327 (23.8%) patients. Clinically stratified high-risk patients had a 3-fold increased risk of the primary end point. The prevalence of abnormal findings on perfusion scans was 29.2% (n=375), and significant CAD was found in 449 (51.8%) of 866 patients who underwent coronary angiography. An abnormal finding on myocardial perfusion scan and the presence of CAD were significantly associated with a 74% and 22% increased risk of cardiovascular events, respectively. In patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n=99), there was an 18% reduction in the risk of all-cause death relative to patients receiving medical treatment (P=.03).ConclusionIn this cohort of middle-aged, asymptomatic patients on dialysis, assessment of CAD identified individuals at higher risk of events, and coronary intervention was associated with reducing the risk of death in selected patients.Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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