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

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. (c) 2005 Elsevier B.V. All rights reserved.