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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Coronary angiography is a better predictor of mortality than noninvasive testing in patients evaluated for renal

Sean A Enkiri1, Angela M Taylor, Ellen C Keeley

  • 1Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 3, 2010
PubMed

Insights

For patients with end-stage renal disease (ESRD) awaiting transplantation, coronary angiography accurately identifies coronary artery disease (CAD) and predicts mortality, unlike noninvasive imaging.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplant Medicine

Background:

  • Coronary artery disease (CAD) is a primary cause of mortality in end-stage renal disease (ESRD) patients.
  • Optimal CAD identification methods for ESRD patients undergoing transplantation evaluation are debated.
  • Limited prognostic data exists comparing noninvasive tests to coronary angiography in this population.

Purpose of the Study:

  • To compare the accuracy of coronary angiography versus noninvasive imaging in identifying CAD.
  • To determine which method better predicts mortality in ESRD patients evaluated for transplantation.

Main Methods:

  • A cohort of 57 patients underwent both coronary angiography and stress perfusion imaging.
  • Severe CAD was defined as ≥70% stenosis on angiography or ischemia in ≥1 zone on noninvasive testing.
  • All-cause mortality was tracked for 3.3 years.

Main Results:

  • Noninvasive imaging revealed ischemia in 63% of patients; angiography showed severe CAD in 40%.
  • Noninvasive imaging demonstrated poor specificity (24%) and positive predictive value (43%) for severe CAD.
  • Angiography, but not noninvasive imaging, predicted survival (3-year survival: 50% with severe CAD vs. 73% without).

Conclusions:

  • False positive results from scintigraphy limited noninvasive imaging utility in ESRD patients.
  • Coronary angiography proved a superior predictor of mortality compared to noninvasive testing in this cohort.
Abstract

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