Canadian-Australasian Randomised trial of screening kidney transplant candidates for coronary artery disease—A trial protocol for the CARSK study

Publication date: August 2019Source: American Heart Journal, Volume 214Author(s): Tracey Ying, Jagbir Gill, Angela Webster, S. Joseph Kim, Rachael Morton, Scott W. Klarenbach, Patrick Kelly, Timothy Ramsay, Gregory A. Knoll, Helen Pilmore, Gillian Hughes, Charles A. Herzog, Steven Chadban, John S. GillTransplantation is the preferred treatment for patients with kidney failure, but the need exceeds the supply of transplantable kidneys, and patients routinely wait>5 years on dialysis for a transplant. Coronary artery disease (CAD) is common in kidney failure and can exclude patients from transplantation or result in death before or after transplantation. Screening asymptomatic patients for CAD using noninvasive tests prior to wait-listing and at regular intervals (ie, annually) after wait-listing until transplantation is the established standard of care and is justified by the need to avoid adverse patient outcomes and loss of organs. Patients with abnormal screening tests undergo coronary angiography, and those with critical stenoses are revascularized. Screening is potentially harmful because patients may be excluded or delayed from transplantation, and complications after revascularization are more frequent in this population. CARSK will test the hypothesis that eliminating screening tests for occult CAD after wait-listing is not inferior to regular screening for the prevention of major adverse cardiac events defined as the composite of cardiovascular death, nonfatal myoca...
Source: American Heart Journal - Category: Cardiology Source Type: research