Validation of a strategy to diagnose coronary artery disease and predict cardiac events in high-risk renal transplant candidates

• Published in: Coronary artery disease Vol. 21; no. 3; pp. 164 - 167
• Main Authors: De Lima, Jose Jayme Galvao, Wolff Gowdak, Luis Henrique, de Paula, Flavio Jota, Ianhez, Luis Estevan, Franchini Ramires, Jose Antonio, Krieger, Eduardo M
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins, Inc 01-05-2010
• Subjects: Algorithms; Chi-Square Distribution; Coronary Angiography; Coronary Stenosis - diagnosis; Coronary Stenosis - etiology; Coronary Stenosis - mortality; Dipyridamole; Exercise Test; Female; Health Status Indicators; Heart Diseases - diagnosis; Heart Diseases - etiology; Heart Diseases - mortality; Humans; Kaplan-Meier Estimate; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Predictive Value of Tests; Proportional Hazards Models; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon
• ISSN: 0954-6928; 1473-5830
• DOI: 10.1097/MCA.0b013e328332ee5e

BACKGROUNDWe validated a strategy for diagnosis of coronary artery disease (CAD) and prediction of cardiac events in high-risk renal transplant candidates (at least one of the followingage ≥50 years, diabetes, cardiovascular disease).
METHODSA diagnosis and risk assessment strategy was used in 228 renal transplant candidates to validate an algorithm. Patients underwent dipyridamole myocardial stress testing and coronary angiography and were followed up until death, renal transplantation, or cardiac events.
RESULTSThe prevalence of CAD was 47%. Stress testing did not detect significant CAD in 1/3 of patients. The sensitivity, specificity, and positive and negative predictive values of the stress test for detecting CAD were 70, 74, 69, and 71%, respectively. CAD, defined by angiography, was associated with increased probability of cardiac events [log-rank0.001; hazard ratio1.90, 95% confidence interval (CI)1.29–2.92]. Diabetes (P=0.03; hazard ratio1.58, 95% CI1.06–2.45) and angiographically defined CAD (P=0.03; hazard ratio1.69, 95% CI1.08–2.78) were the independent predictors of events.
CONCLUSIONThe results validate our observations in a smaller number of high-risk transplant candidates and indicate that stress testing is not appropriate for the diagnosis of CAD or prediction of cardiac events in this group of patients. Coronary angiography was correlated with events but, because less than 50% of patients had significant disease, it seems premature to recommend the test to all high-risk renal transplant candidates. The results suggest that angiography is necessary in many high-risk renal transplant candidates and that better noninvasive methods are still lacking to identify with precision patients who will benefit from invasive procedures.