Abstract 13105: Coronary CT Angiography Predicts Major Adverse Events in Dialysis Dependent End-Stage Renal Disease Patients

Abstract

Introduction: Coronary atherosclerosis is prevalent in the end-stage renal disease population. Cardiovascular complications are the primary cause of morbidity and mortality in this group due to advanced CAD. Coronary CT angiography (CTA) in this population is challenging due to their severe coronary atherosclerosis, often with dense calcifications that limit diagnostic specificity and sensitivity. We characterized the CAD-RADS Classification of 62 ESRD patients on chronic dialysis to assess whether CAD-RADS stratification correlates the severity of disease to major adverse cardiac events. Methods: 62 patients (mean 69 years; range 41-95 years; 59% male) underwent coronary CTA. All patients were on dialysis (83% HD, 10% PD, 7% transition between PD-HD). Average creatinine was 3.9 mg/dL. 38% of patients had history of revascularization either via CABG or PCI. CAD-RADS, coronary artery calcium score (CAC), and other parameters (diabetes mellitus, creatinine, LVEF) were investigated as predictors of cardiac events. Results: Of the 62 patients in this study, 42 patients had significant CAD (CAD-RADS 3 or greater). Average CAC score was 1999.8 Agatston Units (AU). 46 patients (74%) had interpretable CT angiograms. Higher CAC-score moderately correlated with higher CAD-RADS in patients with CAD (R = 0.58, 95% CI, 0.38-0.73, p<0.0001). Analysis revealed that higher CAD-RADS score (>4) is a significant predictor for the presence of major adverse cardiac events (ACS Odds-Ratio 4.03, 95% CI, 1.33-10.68, 61.7% vs 28.5%, p<0.012). In addition, patients with CAD-RADS 4 or greater (including N-scores due to severe calcification), also trended towards higher mortality (Mortality Odds-Ratio 2.0, 95% CI, 0.70-5.57, 52.9% vs 35.7%, p<0.20). Higher CAD-RADS, especially scores >4, had higher incidence of heart failure and decreased cardiac function (LVEF 60.5% vs 47.2%, p<0.003). Conclusions: CAD-RADS classification can be determined in a significant portion of ESRD patients on dialysis, even in the setting of high CAC scores. Higher CAD-RADS scores demonstrated increased incidence of major adverse cardiac events, including heart failure and ACS. This study suggests that cardiac CTA in Dialysis-Dependent-ESRD patients is feasible and prognostic.