Association of Vessel-Specific Coronary Artery Stenosis with Major Adverse Cardiovascular Events in a Renal Transplant Cohort

Aim Coronary artery stenosis is a key risk factor for major adverse cardiovascular events (MACE). Left anterior descending (LAD) artery stenosis is regarded to be the most severe vessel-specific coronary artery stenosis as depicted by its appellation widow-maker. We hypothesised that right coronary artery (RCA) stenoses may present poorer or similar outcomes to LAD. This study sought to investigate the association of vessel-specific coronary artery stenosis using computed tomography coronary angiogram (CTCA) with MACE in a renal transplant cohort. Method This was a single-centre retrospective study of all end-stage renal disease (ESRD) patients eligible for kidney transplantation who underwent CTCA between 2012 to 2014. MACE occurrences (heart failure, AMI, unstable angina, CVA, PVD, and TIA) were recorded within a 10-year follow-up period. CTCA datasets were assessed by 2 independent specialists, visually grading stenosis severity into 2 classifications (<50% or >50% coronary diameter reduction). Results Of 106 patients in our study, a total of 419 coronary arteries (106 RCA, 104 LAD, 104 circumflex (CX), 104 left mainstem (LM)) were graded by CTCA. 43 patients (40.6%) experienced at least one MACE within the timeframe. Statistical significance in MACE was observed when stratified by RCA stenosis severity (p = 0.022) while no statistical significance in MACE observed when stratified by LAD (p = 0.904), CX (p = 0.472) & LM (p = 0.222). Conclusions This challenges the conventional wisdom on individual vessel-specific coronary artery stenosis and suggests that RCA stenoses are associated with MACE in the transplant cohort. This also offers the possibility of RCA stenosis as a prognostic tool in predicting MACE in ESRD patients.