Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates
Author + information
- Simon Winther, MD, PhDa,b,∗ (sw{at}dadlnet.dk),
- My Svensson, MD, PhDc,
- Hanne Skou Jørgensen, MDd,
- Laust Dupont Rasmussen, MSb,
- Niels Ramsing Holm, MDa,
- Lars Christian Gormsen, MD, PhDe,
- Kirsten Bouchelouche, MD, DMSce,
- Hans Erik Bøtker, MD, PhD, DMSca,
- Per Ivarsen, MD, PhDd and
- Morten Bøttcher, MD, PhDb
- aDepartment of Cardiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- bDepartment of Cardiology, Hospital Unit West, Herning, Denmark
- cDepartment of Nephrology, Division of Medicine, Akershus University Hospital, Oslo, Norway
- dDepartment of Nephrology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- eDepartment of Nuclear Medicine and PET-Center, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- ↵∗Address for correspondence:
Dr. Simon Winther, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bulevard 99, DK-8200 Aarhus, Denmark.
Graphical abstract
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.
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.
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.
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.
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)
- coronary angiography
- coronary artery calcium score
- coronary computed tomography angiography
- renal transplantation
- single-photon emission computed tomography
Footnotes
This study was supported by the Karen Elise Jensen Foundation, the Bjørnows Foundation, the Danish Society of Nephrology Research Foundation, and the Health Research Foundation of the Central Denmark Region. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 24, 2017.
- Revision received June 30, 2017.
- Accepted July 5, 2017.
- 2018 American College of Cardiology Foundation
