531 Less Is More: Extensive Cardiac Investigations Add Little Value in Waitlisting Patients for Kidney Transplantation

Abstract

Abstract Aim Extensive cardiac investigations have long been considered necessary to aid decision-making in waitlisting for kidney transplantation. However, the utility and reliability of such comprehensive tests are not well established. This study assessed the prognostic power of coronary artery calcium scoring (CACS) using computed tomography coronary angiogram (CTCA) and myocardial perfusion scintigraphy (MPS) in predicting major adverse cardiac events (MACE). Method We conducted a retrospective study of all ESRD patients considered for kidney transplantation and referred for MPS and/or CTCA for CACS between October 2012 to March 2014 and assessed MACE occurrences (heart failure, cardiac arrest, myocardial infarction, angina, CVA, PVD, and transient ischaemic attack) within a 9-year follow-up period. Results Among 131 patients in our study, 91.6% had a MPS (76.7% Negative MPS result, 23.3% Positive MPS result) and 92.4% had a CTCA (75.2% CACS <400 (Low Score), 24.8% CACS>400 (High Score)). Sensitivity, specificity, positive and negative predictive values were poor for CTCA (38.8%, 84.7% 63.3%, 67.0%) and MPS (34.8%, 82.4%, 55.2%, 67.0%). There was no statistical significance in MACE when stratified by CACS and MPS in transplanted patients (log-rank p= 0.155). No statistical difference in MACE was observed when stratified by MPS status (p=0.749) or CACS status (p=0.706) in non-transplanted patients. Discussion This challenges the value of extensive cardiac assessments (MPS, CTCA) in predicting MACE. Candidates conventionally considered low-risk by these methods had similar risk of MACE when transplanted against higher-risk groups. Thus, such tests are best used for risk stratification and counselling for shared decision-making.