Significance of coronary artery calcification score (CACS) for the detection of coronary artery disease (CAD) in chronic dialysis patients

https://doi.org/10.1016/j.cca.2005.11.028Get rights and content

Abstract

Background

Coronary artery disease (CAD) is a principal cause of death in patients with end-stage renal disease (ESRD). The coronary artery calcification score (CACS), determined by electron-beam computed tomography (EBCT), is useful for the detection of CAD in non-ESRD patients. There are few reports on the usefulness of EBCT for the detection of CAD, however, in ESRD patients. We examined the relation between CACS and CAD in ESRD patients.

Methods

Coronary angiography (CAG) was used to diagnose CAD in patients with significant coronary artery stenosis (≥ 50%). We examined 76 ESRD patients on chronic dialysis therapy from 1997 to 2005, of which 51 are men, 25 are women, mean (S.D.) age of 57.9 (12.1) years and mean (S.D.) HD duration of 7.7 (6.6) years. There were 50 (35 men, 15 women) patients with CAD and 26 (16 men, 10 women) without CAD.

Results

The median CACS was 1290 in all patients, 1689 in the CAD group and 527 in the non-CAD group; the mean (S.D.) CACS was 1833 (2003) in all patients, 2338 (2209) in the CAD group and 861 (991) in the non-CAD group. CACS was significantly higher in the CAD group than in the non-CAD group. The CACS cutoff values for predicting CAD were calculated at intervals of 100. At the cutoff values of ≥ 100, ≥ 500, ≥ 1000, ≥ 2000, and ≥ 3000, the sensitivity was 98%, 90%, 68%, 42%, and 32% and the specificity was 35%, 50%, 69%, 85%, and 96%, respectively.

Conclusions

EBCT is not adequate for screening asymptomatic ESRD patients. Because EBCT is less invasive than CAG, further study is necessary to determine whether CAG should be performed in all high-risk ESRD patients on chronic dialysis.

Introduction

Cardiovascular diseases including coronary artery disease (CAD) are a common cause of death in patients with end-stage renal disease (ESRD) [1], [2]. Once CAD occurs, the long-term prognosis is poor [3], [4]. The incidence of acute myocardial infarction in chronic dialysis patients is high compared to the general population [5]. Therefore, early detection and treatment of CAD is important in this population.

The coronary artery calcification score (CACS) measured by electron-beam computed tomography (EBCT) is useful for detecting CAD in the general population [6], [7], [8], [9], [10], but the clinical significance of CACS in ESRD patients is not known. The present study examined the relationship between CACS and CAD in ESRD patients on chronic dialysis therapy.

Section snippets

Study design

We invited all patients undergoing EBCT and who were receiving regular hemodialysis (HD) at 4R dialysis units of Okinawa to participate in the study. These dialysis units are members of the Okinawa Dialysis Study group and the demographics and dialysis regimen have been published previously [11], [12]. EBCT examinations were performed at the Okinawa Chubu Tokushukai Hospital (Okinawa, Japan). The study period was from 1994 to 2005. A total of 314 patients underwent EBCT after informed consent

Results

We studied 76 patients (51 men, 25 women) with mean (S.D.) age at EBCT examination of 57.9 (12.1) years and mean (S.D.) duration of dialysis of 7.7 (6.6) years at the time of the EBCT examination. Among them, 50 (65.8%) patients were diagnosed with CAD (CAD group), and the remaining 26 patients did not have CAD (non-CAD group). The clinical background is summarized according to the presence or absence of CAD in Table 1.

Mean age at EBCT examination and mean age at start dialysis were higher in

Discussion

Vascular calcification involving the coronary arteries is often observed in ESRD patients. The relationship between vascular calcification and cardiovascular disease has been studied using radiographic methods in ESRD patients. Adragao et al. [14] reported that a vascular calcification score based on plain radiographic films of pelvis and hands of 123 ESRD patients predicted the cardiovascular risk of mortality, cardiovascular disease-related hospitalizations, and cardiovascular events.

Acknowledgements

We are grateful Drs. M. Matsuoka, M. Tozawa, S. Yoshi, N. Higa, and H. Afuso for their support.

References (33)

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