S GLEESON1, J DE ZOYSA2, A TO3
1Renal Department, Middlemore Hospital, Auckland, New Zealand; 2Renal Department, Waitemata District Health Board, Auckland, New Zealand; 3Cardiology Department, Waitemata District Health Board, Auckland, New Zealand
Aim: We prospectively examined computed tomography coronary angiogram (CCTA) use in our cohort of end stage renal failure (ESRF) patients to assess its efficacy and safety.
Background: ESRF patients at risk of coronary artery disease are difficult to evaluate. CCTA has a high negative predictive value but coronary calcifications may limit its use in ESRF.
Methods: We prospectively investigated ESRF patients undergoing CCTA in our institution between 1st November 2012 and 29th February 2016.
CCTAs were performed using 64 row multidetector CT technology (Toshiba 320-slice Aquilion ONE scanner) with prospectively ECG-triggered CCTA acquisition protocol.
Results: 26 patients (mean age 52.6 ± 13.4) were included (42% female, 50% New Zealand European, 15 % Chinese, 15% Pacific Islander). 85% were on renal replacement therapy (RRT) (haemodialysis [82%] renal transplant recipients [18 %]).
The principal indications for referral were: pre-transplant workup (73%) and chest pain work up (19%).
In the pre-transplant assessment group (n = 19), 10 CCTAs showed no/ mild disease, 3 were non-diagnostic, 6 showed obstructive disease.
In the chest pain group (n = 5), 3 CCTAs showed no/ mild disease, 1 showed obstructive disease, 1 was non-diagnostic.
Of the 7 (29%) patients who had obstructive disease on CCTA, 5 proceeded to angiogram, and 3 (60%) were confirmed false positives. 14 (58%) patients had CCTA as their only test.
Discussion: CCTA is a safe and useful test in the evaluation of coronary artery disease in ESRF patients. Concerns over deterioration in renal function and interpretability of the CCTAs were not borne out. Functional or invasive testing was avoided in the majority of patients.