CT coronary angiography is feasible for the assessment of coronary artery disease in chronic dialysis patients, despite high average calcium scores

• Published in: PloS one 2013-07, Vol.8 (7), p.e67936-e67936
• Main Authors: de Bie, Mihály K, Buiten, Maurits S, Gaasbeek, André, Boogers, Mark J, Roos, Cornelis J, Schuijf, Joanne D, Krol, M Jacqueline, Rabelink, Ton J, Bax, Jeroen J, Schalij, Martin J, Jukema, J Wouter
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Blood vessels; Calcification; Calcification (ectopic); Calcium; Calcium - blood; Cardiology; Cardiovascular disease; CAT scans; Catheterization; Clinical Trials as Topic - statistics & numerical data; Computed tomography; Coronary Angiography - methods; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary heart disease; Coronary vessels; Diagnosis; Dialysis; Feasibility Studies; Female; Heart diseases; Heart rate; Heart surgery; Hemodialysis; Humans; Incidence; Intubation; Male; Mathematics; Medical imaging; Medical research; Medicine; Middle Aged; Nephrology; Patients; Prognosis; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnostic imaging; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Research Design; Scanners; Segments; Systematic review; Tomography; Tomography, X-Ray Computed
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0067936

Significant obstructive coronary artery disease (CAD) is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group. For this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861), with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1-3, 5-8, 11 and 13) by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable. A total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70%) were included. The median calcium score was 623 [79, 1619]. Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p