CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates

JOURNAL OF HEPATOLOGY

卷:75

Article

Rachwan, Rayan Jo¹  Kutkut, Issa²  Timsina, Lava R.³  Chaaya, Rody G. Bou⁴  El-Am, Edward A.⁴  Sabra, Mohammad⁴  Mshelbwala, Fakilahyel S.⁵  Rahal, Mahmoud A.⁴  Lacerda, Marco A.⁶  Kubal, Chandrashekhar A.⁷  Fridell, Jonathan A.⁷  Ghabril, Marwan S.⁶  Bourdillon, Patrick D.⁸  Mangus, Richard S.⁷ 

[1] Univ Wisconsin, Div Cardiovasc Med, Sch Med & Publ Hlth, Madison, WI USA

[2] New York Presbyterian Brooklyn Methodist Hosp, Div Cardiol, Brooklyn, NY USA

[3] Indiana Univ Sch Med, Dept Surg, Indianapolis, IN 46202 USA

[4] Indiana Univ Sch Med, Dept Internal Med, Indianapolis, IN 46202 USA

[5] Henry Ford Hosp, Div Cardiol, Detroit, MI 48202 USA

[6] Indiana Univ Sch Med, Dept Internal Med, Div Gastroenterol & Hepatol, Indianapolis, IN 46202 USA

[7] Indiana Univ Sch Med, Dept Transplantat Surg, Indianapolis, IN 46202 USA

[8] Indiana Univ Sch Med, Dept Internal Med, Div Cardiol, Indianapolis, IN 46202 USA

关键词: preoperative evaluation;    stress test;    coronary artery disease;    coronary angiography;    catheterization;    cirrhosis;    liver transplantation;   

DOI  :  10.1016/j.jhep.2021.01.008

来源: Elsevier

【 摘 要 】

Background & Aims: Patients with cirrhosis and significant coronary artery disease (CAD) are at risk of peri-liver transplantation (LT) cardiac events. The coronary artery disease in liver transplantation (CAD-LT) score and algorithm aim to predict the risk of significant CAD in LT candidates and guide pre-LT cardiac evaluation. Methods: Patients who underwent pre-LT evaluation at Indiana University (2010-2019) were studied retrospectively. Stress echocardiography (SE) and cardiac catheterization (CATH) reports were reviewed. CATH was performed for predefined CAD risk factors, irrespective of normal SE. Significant CAD was defined as CAD requiring percutaneous or surgical intervention. A multivariate regression model was constructed to assess risk factors. Receiver-operating curve analysis was used to compute a point-based risk score and a stratified testing algorithm. Results: A total of 1,771 pre-LT patients underwent cardiac evaluation, including results from 1,634 SE and 1,266 CATH assessments. Risk-adjusted predictors of significant CAD at CATH were older age (adjusted odds ratio 1.05; 95% CI 1.03-1.08), male sex (1.69; 1.16-2.50), diabetes (1.57; 1.12-2.22), hypertension (1.61; 1.14-2.28), tobacco use (pack years) (1.01; 1.00-1.02), family history of CAD (1.63; 1.16-2.28), and personal history of CAD (6.55; 4.33-9.90). The CAD-LT score stratified significant CAD risk as low (<-2%), intermediate (3% to 9%), and high (>-10%). Among patients who underwent CATH, a risk-based testing algorithm (low: no testing; intermediate: non-invasive testing vs. CATH; high: CATH) would have identified 97% of all significant CAD and potentially avoided unnecessary testing (669 SE [57%] and 561 CATH [44%]). Conclusions: The CAD-LT score and algorithm (available at www.cad-lt.com) effectively stratify pre-LT risk for significant CAD. This may guide more targeted testing of candidates with fewer tests and faster time to waitlist. Lay summary: The coronary artery disease in liver transplantation (CAD-LT) score and algorithm effectively stratify patients based on their risk of significant coronary artery disease. The CAD-LT algorithm can be used to guide a more targeted cardiac evaluation prior to liver transplantation. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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