Atherosclerosis on CT coronary angiography and the risk of long-term cardiovascular events after liver transplantation

Author:

Sampaio Rodrigues Thalys12,Koshy Anoop N.12,Gow Paul J.3,Weinberg Laurence4,Cailes Benjamin1,Testro Adam3,Smith Gerard5,Lim Han S.12,Teh Andrew W.12,Lim Ruth P.5,Farouque Omar12

Affiliation:

1. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia

2. Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia

3. Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia

4. Department of Anesthesiology, Austin Health, Melbourne, Victoria, Australia

5. Department of Radiology, Austin Health, Melbourne, Victoria, Australia

Abstract

Computed tomography coronary angiography (CTCA) is increasingly utilized for preoperative risk stratification before liver transplantation (LT). We sought to assess the predictors of advanced atherosclerosis on CTCA using the recently developed Coronary Artery Disease-Reporting and Data System (CAD-RADS) score and its impact on the prediction of long-term major adverse cardiovascular events (MACE) following LT. We conducted a retrospective cohort study of consecutive patients who underwent CTCA for LT work-up between 2011 and 2018. Advanced atherosclerosis was defined as coronary artery calcium scores > 400 or CAD-RADS score ≥ 3 (≥50% coronary artery stenosis). MACE was defined as myocardial infarction, heart failure, stroke, or resuscitated cardiac arrest. Overall, 229 patients underwent CTCA (mean age 66 ± 5 y, 82% male). Of these, 157 (68.5%) proceeded with LT. The leading etiology of cirrhosis was hepatitis (47%), and 53% of patients had diabetes before transplant. On adjusted analysis, male sex (OR 4.6, 95% CI 1.5–13.8, p = 0.006), diabetes (OR 2.2, 95% CI 1.2–4.2, p = 0.01) and dyslipidemia (OR 3.1, 95% CI 1.3–6.9, p = 0.005) were predictors of advanced atherosclerosis on CTCA. Thirty-two patients (20%) experienced MACE. At a median follow-up of 4 years, CAD-RADS ≥ 3, but not coronary artery calcium scores, was associated with a heightened risk of MACE (HR 5.8, 95% CI 1.6–20.6, p = 0.006). Based on CTCA results, 71 patients (31%) commenced statin therapy which was associated with a lower risk of all-cause mortality (HR 0.48, 95% CI 0.24–0.97, p = 0.04). The standardized CAD-RADS classification on CTCA predicted the occurrence of cardiovascular outcomes following LT, with a potential to increase the utilization of preventive cardiovascular therapies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation,Hepatology,Surgery

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