Abstract
PurposeSignificant 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.MethodsFor 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.ResultsA 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<0.01).ConclusionDespite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.
Highlights
Survival of patients on dialysis treatment is abysmal. [1] Coronary artery disease (CAD) probably plays an important role in this poor survival and is highly prevalent among dialysis patients.[2,3,4] Noteworthy, the currently reported prevalence is even an underestimation, given the high prevalence of CAD among asymptomatic dialysis patients
Despite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients
The presence of significant CAD on CT was associated with events during follow-up
Summary
Survival of patients on dialysis treatment is abysmal. [1] Coronary artery disease (CAD) probably plays an important role in this poor survival and is highly prevalent among dialysis patients.[2,3,4] Noteworthy, the currently reported prevalence is even an underestimation, given the high prevalence of CAD among asymptomatic dialysis patients. In several studies high prevalences of CAD of ,40% to 50% have been observed, even in asymptomatic dialysis patients.[5,6,7] it was reported that the coronary artery lesions are often (.65% of the cases) located in the proximal parts of the epicardial vessels, which is strongly associated with diminished survival. There are concerns that CTA may be less feasible given the extent of vessel calcification in this patient group.[12,13,14] On the other hand, recent data indicates that even in patients with severe coronary calcification, sensitivity and specificity of CTA remain high. The objective of this study was to evaluate the feasibility of CTA to assess the severity of CAD, in the proximal segments of the coronary arteries, in this vulnerable patient population
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