Prognostic Value of Cardiac Tests in Potential Kidney Transplant Recipients

In Brief Background Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE). Methods We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis. Results Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11–0.29], DSE 24 [95% CI, 0.10–0.38], and coronary angiography 20 [95% CI, 0.08–0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49–0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50–1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38–2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12–10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64–1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71–3.45; P = 0.25). Conclusions Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events. This meta-analysis shows that pretransplant noninvasive cardiac testing was as good as coronary angiography in predicting adverse cardiac events and cardiovascular mortality. Angiography better predicted all-cause mortality. Importantly, 5 percent of patients with negative tests had a cardiac event or cardiovascular mortality posttransplant.