Coronary angiography is a better predictor of mortality than noninvasive testing in patients evaluated for renal transplantation.
OBJECTIVE
The goal of this study was to compare whether coronary angiography or noninvasive imaging more accurately identifies coronary artery disease (CAD) and predicts mortality in patients with end-stage renal disease (ESRD) under evaluation for transplantation.


BACKGROUND
CAD is a leading cause of mortality in patients with ESRD. The optimal method for identifying CAD in ESRD patients evaluated for transplantation remains controversial with a paucity of prognostic data currently available comparing noninvasive methods to coronary angiography.


METHODS
The study cohort consisted of 57 patients undergoing both coronary angiography and stress perfusion imaging. Severe CAD was defined by angiography as ≥ 70% stenosis, and by noninvasive testing as ischemia in ≥ 1 zone. Follow-up for all cause mortality was 3.3 years.


RESULTS
On noninvasive imaging, 63% had ischemia. On angiography, 40% had at least one vessel with severe stenoses. Abnormal perfusion was observed in 56% of patients without severe disease angiographically. Noninvasive imaging had poor specificity (24%) and poor positive predictive value (43%) for identifying severe disease. Angiography but not noninvasive imaging predicted survival; 3 year survival was 50% and 73% for patients with and without severe CAD by angiography (p<0.05).


CONCLUSIONS
False positive scintigrams limited noninvasive imaging in patients with ESRD. Angiography was a better predictor of mortality compared with noninvasive testing.
Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Sean A
SA
Enkiri
Angela M
AM
Taylor
Ellen C
EC
Keeley
Lewis C
LC
Lipson
Lawrence W
LW
Gimple
Michael
M
Ragosta
D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014768:Virginia