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Effectively Screening for Coronary Artery Disease in Patients Undergoing Orthotopic Liver Transplant Evaluation
Bryan C Lee1, Feng Li1, Adam J Hanje2
1Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Insights
Coronary artery disease (CAD) is common in patients awaiting liver transplants. Patients with two or more risk factors have a 50% chance of having CAD, highlighting the need for standardized screening protocols.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) is frequent in end-stage liver disease patients.
- CAD negatively impacts outcomes following orthotopic liver transplantation (OLT).
- Noninvasive CAD screening in this population has limited sensitivity.
Purpose of the Study:
- To evaluate the prevalence of CAD in patients undergoing OLT evaluation.
- To analyze the effectiveness of current CAD screening practices.
- To identify factors associated with CAD in pre-OLT patients.
Main Methods:
- Retrospective review of 132 patients evaluated for OLT between May 2009 and February 2014.
- Analysis of demographic, clinical, and procedural characteristics.
- Comparison of initial screening methods (stress testing vs. coronary angiography).
Main Results:
- Initial screening predominantly used stress testing (75.8%) over angiography (24.2%).
- Of those undergoing angiography, 23.5% had CAD.
- Two or more traditional risk factors were associated with a 50% prevalence of CAD (OR 1.92, p=0.026).
Conclusions:
- CAD is highly prevalent in patients awaiting OLT, particularly those with multiple risk factors.
- Current screening practices lack uniformity.
- Evidence-based, standardized screening protocols are needed for pre-OLT patients.
Abstract:
Coronary artery disease (CAD) is prevalent in patients with end-stage liver disease and associated with poor outcomes when undergoing orthotopic liver transplantation (OLT); however, noninvasive screening for CAD in this population is less sensitive. In an attempt to identify redundancy, we reviewed our experience among patients undergoing CAD screening as part of their OLT evaluation between May 2009 and February 2014. Demographic, clinical, and procedural characteristics were analyzed. Of the total number of screened patients (n = 132), initial screening was more common via stress testing (n = 100; 75.8%) than coronary angiography (n = 32; 24.2%). Most with initial stress testing underwent angiography (n = 52; 39.4%). Among those undergoing angiography, CAD was common (n = 31; 23.5%). Across the entire cohort the number of traditional risk factors was linearly associated with CAD, and those with two or more risk factors were found to have CAD by angiography 50% of the time (OR 1.92; CI 1.07-3.44, p = 0.026). Our data supports that CAD is prevalent among pre-OLT patients, especially among those with 2 or more risk factors. Moreover, we identified a lack of uniformity in practice and the need for evidence-based and standardized screening protocols.
