[Coronary calcium score as predictor of stenosis and events in pretransplant renal chronic failure].
BACKGROUND
Coronary artery disease (CAD) is the major cause of death among chronic renal failure (CRF) patients. Traditional, non-invasive exams to detect CAD and to predict events have shown insufficient results in this group. CT Scan evaluation of Coronary Calcium Score (CCS) has proven to be of prognostic value for the population reporting no renal condition.


OBJECTIVE
To investigate CCS accuracy in detecting obstructive CAD and in predicting cardiovascular events in candidates to renal transplant as compared to quantitative invasive coronary angiography (ICA).


METHODS
Ninety-seven (97) CRF patients aged > or =35 were evaluated. Obstructive CAD was considered as > or =50% or > or =70% stenosis on ICA. Descriptive data, concordance, diagnostic tests, Kaplan-Meier, and multivariate analysis were used.


RESULTS
Agatston mean score was 580.6 +/- 1,102.2. Minimum and maximum values were 0 and 7,994, with median at 176. Only 14 patients had zero calcium score. No differences were reported in regard to ethnicity. Highest regional calcium was associated to the highest probability of coronary stenosis in the same segment. Agatston calcium score showed high accuracy for the diagnosis of > or =50% and > or =70% stenosis, with area under ROC curve (AUC) of 0.75 and 0.70, respectively. At the threshold of 400, calcium score identified a subgroup with a higher rate of cardiovascular events at an average follow-up time of 29+/-11.0 months.


CONCLUSIONS
CCS proved to have good diagnostic and prognostic performance for cardiovascular events evaluation in CRF patients.
Rosário
Miguel Abraão
MA
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Lima
José Jayme de
JJ
Parga
José R
JR
Avila
Luiz F
LF
Gowdak
Luis H
LH
Lemos
Pedro A
PA
Rochitte
Carlos E
CE
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*