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Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2018 Jun; Vol. 11 (6), pp. 842-854. Date of Electronic Publication: 2017 Sep 13. - Publication Year :
- 2018
-
Abstract
- Objectives: This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates.<br />Background: Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value.<br />Methods: The study prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients' interviews, patients' records, and registries.<br />Results: The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death.<br />Conclusions: Compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates. Applying a combination of risk factors and CACS and subsequently coronary CTA seems to be the most appropriate strategy. (Angiographic CT of Renal Transplantation Candidate Study [ACToR]; NCT01344434).<br /> (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Coronary Artery Disease complications
Coronary Artery Disease mortality
Coronary Artery Disease physiopathology
Coronary Vessels physiopathology
Female
Humans
Kidney Diseases complications
Kidney Diseases diagnosis
Kidney Diseases mortality
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Calcification complications
Vascular Calcification mortality
Vascular Calcification physiopathology
Young Adult
Computed Tomography Angiography
Coronary Angiography methods
Coronary Artery Disease diagnostic imaging
Coronary Circulation
Coronary Vessels diagnostic imaging
Kidney Diseases surgery
Kidney Transplantation adverse effects
Kidney Transplantation mortality
Myocardial Perfusion Imaging methods
Tomography, Emission-Computed, Single-Photon
Vascular Calcification diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 11
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 28917674
- Full Text :
- https://doi.org/10.1016/j.jcmg.2017.07.012