title: Prognostic value of cardiac tests in potential kidney transplant recipients: a systematic review.
abstract: BACKGROUND
  Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE).
  
  
  METHODS
  We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis.
  
  
  RESULTS
  Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11-0.29], DSE 24 [95% CI, 0.10-0.38], and coronary angiography 20 [95% CI, 0.08-0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49-0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50-1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38-2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12-10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64-1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71-3.45; P = 0.25).
  
  
  CONCLUSIONS
  Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events.
authors.affiliation: 1 Department of Cardiology, St Vincent's Hospital, Sydney, Australia and St Vincent's Clinical School, University of New South Wales, Australia. 2 Sydney School of Public Health, University of Sydney, Australia. 3 School of Public Health and Community Medicine, University of New South Wales, Australia. 4 Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. 5 Department of Nephrology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom. 6 Cochrane Renal Group and Centre for Transplant and Kidney Research, Westmead Hospital, Australia.
authors.forename: Louis W
authors.initials: LW
authors.lastname: Wang
authors.forename: Philip
authors.initials: P
authors.lastname: Masson
authors.forename: Robin M
authors.initials: RM
authors.lastname: Turner
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Lord
authors.forename: Laura A
authors.initials: LA
authors.lastname: Baines
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Angela C
authors.initials: AC
authors.lastname: Webster
mesh_terms: D016009:Chi-Square Distribution; D003935:Diagnostic Techniques, Cardiovascular; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome