title: Myocardial scintigraphy and clinical stratification as predictors of events in renal transplant candidates.
abstract: BACKGROUND
  We tested the hypothesis that the universal application of myocardial scanning with single-photon emission computed tomography (SPECT) would result in better risk stratification in renal transplant candidates (RTC) compared with SPECT being restricted to patients who, in addition to renal disease, had other clinical risk factors.
  
  
  METHODS
  RTCs (n=363) underwent SPECT and clinical risk stratification according to the American Society of Transplantation (AST) algorithm and were followed up until a major adverse cardiovascular event (MACE) or death.
  
  
  RESULTS
  Of the 363 patients, 79 patients (22%) had an abnormal SPECT scan and 270 (74%) were classified as high risk. Both methods correctly identified patients with increased probability of MACE. However, clinical stratification performed better (sensitivity and negative predictive value 99% and 99% vs. 25% and 87%, respectively). High-risk patients with an abnormal SPECT scan had a modest increased risk of events (log-rank = 0.03; hazard ratio [HR] = 1.37; 95% confidence interval [95% CI], 1.02-1.82). Eighty-six patients underwent coronary angiography, and coronary artery disease (CAD) was found in 60%. High-risk patients with CAD had an increased incidence of events (log-rank = 0.008; HR=3.85; 95% CI, 1.46-13.22), but in those with an abnormal SPECT scan, the incidence of events was not influenced by CAD (log-rank = 0.23). Forty-six patients died. Clinical stratification, but not SPECT, correlated with the probability of death (log-rank = 0.02; HR=3.25; 95% CI, 1.31-10.82).
  
  
  CONCLUSIONS
  SPECT should be restricted to high-risk patients. Moreover, in contrast to SPECT, the AST algorithm was also useful for predicting death by any cause in RTCs and for selecting patients for invasive coronary testing.
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo - Brazil.
authors.forename: Rodolfo L
authors.initials: RL
authors.lastname: Arantes
authors.forename: Luis Henrique W
authors.initials: LH
authors.lastname: Gowdak
authors.forename: Flavio J de
authors.initials: FJ
authors.lastname: Paula
authors.forename: Luis Estevan
authors.initials: LE
authors.lastname: Ianhez
authors.forename: Jose Antonio F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Krieger
authors.forename: José Jayme G
authors.initials: JJ
authors.lastname: De Lima
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon