Accuracy of Myocardial Perfusion Imaging (MPI) in Predicting Post Transplant Cardiovascular Events among Diabetic Kidney Transplant Candidates: A tertiary care centre experience from Saudi Arabia

Background Cardiovascular risk assessment is crucial before kidney transplantation, especially for diabetic patients, as 6.6% experience major adverse cardiovascular events (MACE) within three years. Myocardial perfusion imaging (MPI) is commonly used to evaluate this risk. Objective This study assessed MPI’s ability to predict post-transplant cardiovascular events in asymptomatic diabetic candidates by examining its diagnostic accuracy for obstructive coronary artery disease (CAD) compared to coronary angiography and analyzing MACE incidence over two years. Methods In this retrospective, single-center study, 121 diabetic patients who underwent stress MPI before kidney transplantation were followed for two years post-transplant. The primary outcome included death, acute coronary syndrome (ACS), coronary revascularization, acute decompensated heart failure (ADHF), and cerebrovascular accident (CVA). Diagnostic metrics for MPI were evaluated in candidates undergoing pre-transplant coronary angiography. Results Among 121 candidates, 76 had normal MPI, and 45 had abnormal MPI. MACE occurred in 11.8% of normal MPI patients and 8.9% of abnormal MPI patients. MPI showed sensitivity of 60%, specificity of 59.7%, NPV of 85%, and PPV of 27.9% for obstructive CAD detection. Conclusion Despite NPV of 85% for ruling out obstructive coronary artery disease, stress MPI is not a reliable predictor of post kidney transplant adverse cardiovascular events in diabetic kidney transplant candidates. Findings of normal MPI should be interpreted with caution and we recommend against over utilization of stress MPI in diabetic kidney transplant candidates to avoid post-transplant cardiovascular events.