Diagnostic performance of computed tomographic coronary angiography in patients with end-stage renal disease Borut Jug a,c , Jenny Papazian a , Mohit Gupta a , Harpreet Bhatia b , Arya Derakhshani b , Sheri Koplik b , Ronald P. Karlsberg b and Matthew J. Budoff a Background End-stage renal disease (ESRD) is characterized by a very high rate of cardiovascular events that warrants thorough screening for coronary atherosclerosis, especially in patients undergoing a kidney transplant. Therefore, we assessed the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in patients with ESRD. Methods We included patients who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) within 6 months, either as part of clinical work-up in two urban medical centers or as part of the multicenter ACCURACY trial. Results Thirty-one ESRD patients were included and compared with 588 non-ESRD patients undergoing CCTA and invasive coronary angiography. On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect at least 50% and at least 70% stenosis were 100, 78, 92, and 100% and 100, 91, 95, and 100%, respectively, for ESRD patients and 97, 83, 87, and 96% and 94, 87, 85, and 95%, respectively, for non-ESRD controls. There were no statistically significant differences between ESRD and non-ESRD participants in diagnostic performance measures. Conclusion Results show 64-row multidetector CCTA is highly sensitive and specific in the detection of coronary artery stenosis irrespective of ESRD. Our findings suggest that CCTA is a promising diagnostic tool for the timely detection and/or exclusion of coronary atherosclerosis in patients undergoing pretransplant cardiovascular surveillance. Coron Artery Dis 24:135–141  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Coronary Artery Disease 2013, 24:135–141 Keywords: atherosclerosis, computed tomographic angiography, diagnostic accuracy, end-stage renal disease, multidetector computed tomography a Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, b Cardiovascular Medical Group of Southern California, Los Angeles, California, USA and c Preventive Cardiology Unit, Department of Vascular Diseases, University Medical Center, Ljubljana, Slovenia Correspondence to Borut Jug, MD, Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, Building E-5, 1124 W Carson St., Torrance, CA 90502, USA Tel: + 1 31 022 2410 7; fax: + 1 31 078 2965 2; e-mail: borut.jug@gmail.com Received 5 August 2012 Revised 19 October 2012 Accepted 25 October 2012 Introduction End-stage renal disease (ESRD) is associated with a high prevalence of coronary atherosclerosis and excessive cardiovascular mortality [1–5]. Vascular risk is especially high in patients undergoing kidney transplantation who experience a dramatic increase in the rate of cardio- vascular events during the immediate peritransplant period [3,6]. Therefore, patients with ESRD typically undergo extensive cardiovascular screening before inclu- sion on a kidney transplant waiting list – not only in view of a potential therapeutic intervention but also to regulate access to a limited supply of donor organs [7–9]. The diagnosis of coronary atherosclerosis in patients with ESRD is particularly challenging. Comorbidity, poor exercise capacity, and a high prevalence of cardiovascular abnormalities limit the diagnostic accuracy of ischemia- driven tests [10]. In this respect, coronary computed tomographic angiography (CCTA) represents a promising method for the noninvasive detection of coronary artery disease (CAD) [11], and may provide a much-appreciated improvement in cardiovascular assessment of patients with ESRD. Therefore, the present study aimed to assess the diagnostic performance of 64-slice multidetector CCTA in patients with ESRD. Methods Study population The study population was pooled from two separate sources: (i) the prospectively conducted ACCURACY trial and (ii) the joint database of CCTA diagnostic procedures performed at two Los Angeles medical centers between September 2006 and May 2010 (retro- spective cohort). Details of the ACCURACY study population have been described elsewhere [11]; in brief, it included individuals with chest pain referred for coronary angiography who underwent CCTA as part of the study protocol. For the retrospective cohort, patients were included in the analysis if they had been referred for a diagnostic work- up of chest pain, and had available CCTA and invasive coronary angiography images with both diagnostic proce- dures performed no more than 6 months apart. Patients with a history of coronary artery by-pass grafting, irregular Diagnostic methods 135 0954-6928  c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MCA.0b013e32835be39a Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.