Background: This study addresses the safety, feasibility, and interpretability of coronary
computed tomography angiography (CCTA) in excluding significant coronary artery disease
in end-stage renal disease patients on dialysis undergoing pre-renal transplant cardiac risk
evaluation.
Methods: Twenty nine patients (55.5 ± 10.2 years) undergoing cardiac risk assessment
prior to renal transplantation, underwent research CCTA with calcium scoring and formed
the study group. All CCTAs were performed using retrospective acquisition, with beta-blockade
provided one hour prior to scanning.
Results: No major complications occurred in this group up to 30 days after CCTA. Of the
total of 374 segments interpreted by both readers, only 36 (10%) were uninterpretable by both
readers. Of these, 31 (86%) were from distal segments or branches. On a segmental level, there
was 95% concordance between both readers for < 50% stenosis detection. Only three out of
28 (11%) CCTAs were deemed uninterpretable. Ten patients (36%) had zero calcium score,
despite being on dialysis with no evidence of obstructive coronary artery disease by CCTA.
Conclusions: CCTA is feasible and safe in end-stage renal disease dialysis patients with the
advent of 64-slice CCTA. Despite significant calcium burden, there was excellent inter-observer
agreement at segment level for the left main and all three proximal-mid coronary
arteries in excluding obstructive coronary artery disease (> 50% stenosis). (Cardiol J 2010;
17, 4: 349-361