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High Coronary Artery Calcium Score Is Associated With Increased Major Adverse Cardiac Events After Liver
Amanda Su1, Erik Almazan1, Vorada Sakulsaengprapha1
1Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Coronary artery calcium (CAC) scoring can identify liver transplant candidates at higher risk for major adverse cardiovascular events (MACEs). While CAC scores did not predict overall mortality, a CAC score over 400 significantly increased MACE risk post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Radiology
Background:
- Liver transplantation (LT) candidates often present with cardiovascular risk factors.
- Cardiovascular disease is a leading cause of post-LT morbidity and mortality.
- Coronary artery calcium (CAC) scoring is a noninvasive method to assess coronary artery disease.
Purpose of the Study:
- To investigate the association between pretransplant CAC scores and post-LT cardiovascular outcomes.
- To determine if CAC scores can predict major adverse cardiovascular events (MACEs) and all-cause mortality after LT.
Main Methods:
- Retrospective analysis of 227 adult patients undergoing first LT between 2010 and 2019 with pretransplant CAC scores.
- Patients categorized into four CAC score groups: 0, 1-100, 101-400, and >400.
- Cox regression analysis used to assess associations between CAC score and MACE or all-cause mortality within 5-year follow-up.
Main Results:
- After 5 years, 20.7% of patients experienced death and 20.7% experienced MACE.
- Multivariable analysis showed no significant difference in all-cause mortality across CAC score groups.
- Patients with CAC scores >400 had a significantly higher risk of MACE (HR 2.58, 95% CI 1.05-6.29) compared to those with CAC score 0.
Conclusions:
- Pretransplant CAC score is not associated with all-cause mortality after LT.
- Elevated CAC scores (>400) are linked to an increased risk of MACE within 5 years post-LT.
- Further research is needed to refine cardiac risk stratification in LT candidates using CAC scoring.
Abstract:
Liver transplantation (LT) candidates frequently have multiple cardiovascular risk factors, and cardiovascular disease is a major cause of morbidity and mortality after LT. Coronary artery calcium (CAC) scores are a noninvasive assessment of coronary artery disease using computed tomography. This study examines CAC scores and cardiac risk factors and their association with outcomes after LT.
Methods:
Patients who underwent LT between January 2010 and June 2019 with a pretransplant CAC score were included in this study. Patients were divided by CAC score into 4 groups (CAC score 0, CAC score 1-100, CAC score 101-400, CAC score >400). Major adverse cardiovascular events (MACEs) were defined as myocardial infarction, stroke, revascularization, heart failure, atrial fibrillation, and cardiovascular death. Associations between CAC score and MACE or all-cause mortality within the 5-y post-LT follow-up period were analyzed using Cox regression. Statistical significance was defined as P < 0.05.
Results:
During the study period, 773 adult patients underwent their first LT, and 227 patients met our study criteria. The median follow-up time was 3.4 (interquartile range 1.9, 5.3) y. After 5 y, death occurred in 47 patients (20.7%) and MACE in 47 patients (20.7%). In multivariable analysis, there was no difference in death between CAC score groups. There was significantly higher risk of MACE in the CAC score >400 group, with a hazard ratio 2.58 (95% confidence interval 1.05, 6.29).
Conclusions:
CAC score was not associated with all-cause mortality. Patients with CAC score >400 had an increase in MACEs within the 5-y follow-up period compared with patients with a CAC score = 0. Further research with larger cohorts is needed to examine cardiac risk stratification in this vulnerable patient population.
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