Coronary XXXX Score May Replace Cardiovascular Risk Factors as Primary Risk Stratification Tool Before Kidney Transplantation.

@entity1 @entity453 @entity65 @entity460
BACKGROUND: Cardiac evaluation before kidney transplantation is recommended, but no unequivocal screening strategy has yet been identified. We investigated if coronary artery @entity460 score (CACS) can replace @entity65 factor assessment in selection of kidney transplantation candidates for cardiac evaluation and the choice of noninvasive modality for diagnosing obstructive @entity453 ( @entity453 ). METHODS: We conducted a prospective study of 167 @entity1 referred for pretransplantation cardiac evaluation. @entity1 underwent risk factor assessment, CACS, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography. In total, 138 @entity1 completed all diagnostic tests. RESULTS: In @entity1 with @entity453 (22%), the number of risk factors and CACS score were higher than that in @entity1 without @entity453 . The accuracy evaluated by the receiver-operating characteristic curve was higher for CACS than for risk factors, 0.85 versus 0.71 (P = 0.01). Adding CACS to the risk factor increased correct categorical net reclassification (0.58, P < 0.0001). Combining risk factors (>= 3) with SPECT to identify @entity1 with obstructive @entity453 resulted in less sensitivity (47% vs 80%) and higher specificity (94% vs 74%), compared with CCTA. In @entity1 with low CACS (<400), SPECT had a lower sensitivity than CCTA (60% versus 80%) but the same specificity (80%). In @entity1 with high CACS (>= 400), SPECT had lower sensitivity than CCTA (50% vs 100%) and higher specificity (88% vs 8%). CONCLUSIONS: In kidney transplantation candidates, CACS outperformed risk factor assessment for predicting obstructive @entity453 and is a better tool for selecting @entity1 and guiding the choice of noninvasive diagnostic modality in @entity453 .
