Association of Moderate Coronary Artery Disease Burden With Major Adverse Cardiovascular Events Following Kidney Transplantation.

Coronary artery disease (CAD) is the leading cause of mortality in kidney transplant (KT) recipients. While KT candidates with severe CAD often undergo revascularization, the impact of moderate, nonobstructive CAD remains unclear. In this retrospective study of KT recipients at Saint Louis University Hospital (2015-2024), we evaluated patients who underwent pre-transplant invasive coronary angiography but had no stenosis >70% and did not receive coronary revascularization before transplant. Patients were grouped by the number of coronary vessels with moderate 50% to 70% stenosis: none (0V), 1-2-vessel (1-2V), and 3-vessel (3V) disease. The primary outcome was post-KT major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, hospitalization for heart failure, arrhythmia, percutaneous coronary intervention or coronary artery bypass surgery Among 174 KT patients who underwent pre-KT coronary angiography and had moderate CAD, MACE occurred in 9.4%, 14.8%, and 37.5% of the 0V, 1-2V, and 3V groups. After adjustment, 3V disease was associated with a higher risk of MACE (hazard ratio 3.30, 95% CI:1.27-8.56). Left anterior descending artery (LAD) involvement was also independently associated with MACE (P = .004).