Introduction Stress myocardial perfusion imaging (MPI) is recommended to risk stratify patients undergoing renal transplantation. Patients with positive MPI studies are likely to need further invasive angiography. The aim of this study was to create a novel clinical risk score (CRS) to help triage patients to a single modality of non-invasive or invasive assessment prior to transplantation.

Method A review of the risk factor profile of 39 patients undergoing stress MPI prior to renal transplantation was undertaken. The CRS was developed as follows (one point if present): Age >65​; BMI >30; Smoking​ history​; Hypertension; Diabetes; Vascular history. The CRS was applied to patients and compared with the outcome of the MPI.

Results 20 male and 19 female patients were identified. 4 patients were excluded (incomplete data). 5 patients had positive MPI studies. The characteristics of patients with positive and negative MPI is in Table 1. The patient with a CRS score of zero had a negative MPI. 7.2% (26/28) of patients with a CRS of 1–3 had a positive stress MPI compared with 50% (3/6) in those with a CRS of 4 or greater. These patients required additional evaluation after MPI.

Conclusion

1. Patients with CRS of zero may not need non-invasive assessment prior to renal transplant.

2. Patients with a CRS of 1–3 are best assessed by non-invasive stress imaging initially.

3. In patients with CRS of 4 and greater, invasive angiography may be more appropriate as the single investigative modality.

4. Larger studies are needed to validate these findings.