Predicting Cardiac Prognosis in Asymptomatic Chronic Kidney Disease Patients

We read with interest the recent study by Winther et al. (1) that addressed the best noninvasive or invasive test for predicting cardiac prognosis in asymptomatic chronic kidney disease (CKD) patients. In this study, 154 patients referred for kidney transplantation assessment underwent coronary artery calcium score, coronary computed tomography angiography, single-photon emission computed tomography, and invasive coronary angiography and were followed up for a mean of 3.7 years. The primary endpoint was major adverse cardiac events (MACE) defined as 1 of the following events: cardiac death, cardiac arrest with successful resuscitation, ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or coronary revascularization. The secondary endpoint was all-cause mortality. Coronary artery calcium and abnormal coronary computed tomography angiography and invasive coronary angiography findings were predictive of MACE even after adjustment for renal transplantation and presence of more than 3 risk factors during follow-up.