Diagnostic performance of computed tomographic coronary angiography in patients with end-stage renal disease.
BACKGROUND
End-stage renal disease (ESRD) is characterized by a very high rate of cardiovascular events that warrants thorough screening for coronary atherosclerosis, especially in patients undergoing a kidney transplant. Therefore, we assessed the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in patients with ESRD.


METHODS
We included patients who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) within 6 months, either as part of clinical work-up in two urban medical centers or as part of the multicenter ACCURACY trial.


RESULTS
Thirty-one ESRD patients were included and compared with 588 non-ESRD patients undergoing CCTA and invasive coronary angiography. On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect at least 50% and at least 70% stenosis were 100, 78, 92, and 100% and 100, 91, 95, and 100%, respectively, for ESRD patients and 97, 83, 87, and 96% and 94, 87, 85, and 95%, respectively, for non-ESRD controls. There were no statistically significant differences between ESRD and non-ESRD participants in diagnostic performance measures.


CONCLUSIONS
Results show 64-row multidetector CCTA is highly sensitive and specific in the detection of coronary artery stenosis irrespective of ESRD. Our findings suggest that CCTA is a promising diagnostic tool for the timely detection and/or exclusion of coronary atherosclerosis in patients undergoing pretransplant cardiovascular surveillance.
Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California 90502, USA. borut.jug@gmail.com
Borut
B
Jug
Jenny
J
Papazian
Mohit
M
Gupta
Harpreet
H
Bhatia
Arya
A
Derakhshani
Sheri
S
Koplik
Ronald P
RP
Karlsberg
Matthew J
MJ
Budoff
D006328:Cardiac Catheterization; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity