Objectives This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates.

Background Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value.

Methods The study prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients’ interviews, patients’ records, and registries.

Results The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death.

Conclusions Compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates. Applying a combination of risk factors and CACS and subsequently coronary CTA seems to be the most appropriate strategy. (Angiographic CT of Renal Transplantation Candidate Study [ACToR]; NCT01344434)

目的本研究旨在对临床危险因素和各种心脏成像方式（包括冠状动脉钙化评分（CACS），冠状动脉计算机断层造影血管造影（CTA），单光子发射）的预测价值进行前瞻性比较。计算机断层扫描（SPECT）和有创冠状动脉造影（ICA）评估肾移植候选者的主要不良心脏事件（MACE）和全因死亡率。

背景技术当前的指南建议在肾移植候选物中筛查冠状动脉疾病。此外，尽管诊断准确性低且预后不确定，但在当前指南中仍建议使用非侵入性应力成像。

方法前瞻性评估了154例接受肾脏移植的患者。所有患者均接受了CACS，冠状动脉CTA，SPECT和ICA测试。从患者的访谈，患者的病历和登记簿中提取临床终点。

结果平均随访时间为3。7年。总共有27（17.5％）名患者经历了MACE，有31名（20.1％）患者在随访期间死亡。在事件分析中，危险因素和CACS均能显着预测死亡，而CACS只能预测MACE。将危险因素与CACS相结合，确定出低危人群，其MACE事件发生率为2.1％，每年的死亡率为1.0％。在诊断方式中，冠状动脉CTA和ICA可以显着预测MACE，但只有冠状动脉CTA可以预测死亡。相反，SPECT既不预测MACE也不死亡。

结论与传统的危险因素和其他心脏成像方式相比，CACS和冠状动脉CTA似乎在肾移植候选者的危险分层方面具有优势。结合使用危险因素和CACS并随后进行冠状动脉CTA似乎是最合适的策略。（肾移植候选人的血管造影CT研究[ACToR]； NCT01344434）