Coronary artery calcium score (CACS) predicted significant coronary artery stenosis (SCAS) with an AUC of 0.88, allowing stratification of transplant patients into low or high risk for SCAS.
Does coronary artery calcium score (CACS) accurately predict significant coronary artery stenosis in pre-liver and pre-renal transplant patients?
CACS is a highly accurate screening tool (AUC 0.88) for predicting significant coronary artery stenosis in pre-liver and pre-kidney transplant patients, potentially reducing the need for CCTA in low-risk individuals.
Absolute Event Rate: 0% vs 0%
Objective: This study aims to assess the diagnostic value of the coronary artery calcium score (CACS) to predict significant coronary artery stenosis (SCAS) in presolid organ transplant patients with a moderate and high risk of coronary artery disease. Methods: In this retrospective HIPAA-compliant study, all pre-liver/kidney transplant patients with intermediate or high risk of coronary artery disease who underwent cardiac CT angiogram (CCTA) and CACS between January 1, 2018 and December 31, 2022 were reviewed. CACS was assessed according to the Agatston score. SCAS was defined as ≥50% diameter stenosis on CCTA. The potential to predict SCAS was assessed by computing the area under the receiver curve (AUC), and the sensitivity and specificity of CACS in diagnosing SCAS were calculated at various CACS thresholds. Results: A total of 291 patients (81; 28% female) with a mean age of 57.7±9.9 years, were included. The median CACS was 772 (IQR: 320 to 1892) in patients with SCAS versus 23 (IQR: 0 to 187) in those without SCAS ( P <0.01). CACS demonstrated efficacy in predicting SCAS, with an AUC of 0.88. In the subgroup analysis, mean CACS differed significantly between pre-liver and pre-kidney solid organ transplant patients, but the difference between AUC curves was not significant. With the use of traditional CACS thresholds, the sensitivity dropped below 95%, but with optimized thresholds of CACS ≤62 or ≥869 for 95% sensitivity and specificity, 63% of pretransplant patients could be attributed either to a low-risk or high-risk for SCAS, respectively. Conclusions: Our study shows that CACS can accurately predict SCAS in a large proportion of pre-kidney and liver transplant patients with intermediate or high risk of coronary artery disease. CACS can be considered as a screening tool to identify patients with low likelihood of SCAS, who might not require CCTA, as well as those with a high likelihood in whom a proactive approach should be considered.
Liberman et al. (Wed,) reported a other. Coronary artery calcium score (CACS) predicted significant coronary artery stenosis (SCAS) with an AUC of 0.88, allowing stratification of transplant patients into low or high risk for SCAS.