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Published on: September 22, 2023
Could Calcium Score Serve as a Screening Tool to Rule Out Significant Coronary Artery Stenosis in Pre-liver and
Yuval Liberman1, Om Biju Panta1, Nitai Bar1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Insights
The coronary artery calcium score (CACS) accurately predicts significant coronary artery stenosis (SCAS) in pre-transplant patients. This tool helps identify low-risk patients who may not need further imaging, and high-risk patients for proactive management.
Area of Science:
- Cardiology
- Radiology
- Transplant Medicine
Background:
- Coronary artery disease (CAD) poses a significant risk for solid organ transplant recipients.
- Pre-transplant cardiac evaluation is crucial for risk stratification.
- Non-invasive imaging modalities are essential for assessing CAD risk in this population.
Purpose of the Study:
- To evaluate the diagnostic accuracy of coronary artery calcium scoring (CACS) in predicting significant coronary artery stenosis (SCAS).
- To assess the utility of CACS in pre-liver and pre-kidney transplant candidates with intermediate to high CAD risk.
- To determine optimal CACS thresholds for risk stratification in pre-transplant patients.
Main Methods:
- Retrospective analysis of 291 pre-transplant patients (liver/kidney) who underwent cardiac CT angiography (CCTA) and CACS.
- SCAS defined as ≥50% diameter stenosis on CCTA.
- Area under the receiver curve (AUC), sensitivity, and specificity calculated for CACS in predicting SCAS.
Main Results:
- CACS showed high efficacy in predicting SCAS with an AUC of 0.88.
- Median CACS was significantly higher in patients with SCAS (772) compared to those without (23).
- Optimized CACS thresholds (≤62 or ≥869) achieved 95% sensitivity and specificity, classifying 63% of patients into low or high-risk categories.
Conclusions:
- CACS is an effective tool for predicting SCAS in pre-transplant patients with intermediate or high CAD risk.
- CACS can identify patients unlikely to have SCAS, potentially avoiding CCTA.
- CACS aids in identifying high-risk patients who may benefit from proactive management strategies.
Objective:
This study aims to assess the diagnostic value of the coronary artery calcium score (CACS) to predict significant coronary artery stenosis (SCAS) in presolid organ transplant patients with a moderate and high risk of coronary artery disease.
Methods:
In this retrospective HIPAA-compliant study, all pre-liver/kidney transplant patients with intermediate or high risk of coronary artery disease who underwent cardiac CT angiogram (CCTA) and CACS between January 1, 2018 and December 31, 2022 were reviewed. CACS was assessed according to the Agatston score. SCAS was defined as ≥50% diameter stenosis on CCTA. The potential to predict SCAS was assessed by computing the area under the receiver curve (AUC), and the sensitivity and specificity of CACS in diagnosing SCAS were calculated at various CACS thresholds.
Results:
A total of 291 patients (81; 28% female) with a mean age of 57.7±9.9 years, were included. The median CACS was 772 (IQR: 320 to 1892) in patients with SCAS versus 23 (IQR: 0 to 187) in those without SCAS ( P <0.01). CACS demonstrated efficacy in predicting SCAS, with an AUC of 0.88. In the subgroup analysis, mean CACS differed significantly between pre-liver and pre-kidney solid organ transplant patients, but the difference between AUC curves was not significant. With the use of traditional CACS thresholds, the sensitivity dropped below 95%, but with optimized thresholds of CACS ≤62 or ≥869 for 95% sensitivity and specificity, 63% of pretransplant patients could be attributed either to a low-risk or high-risk for SCAS, respectively.
Conclusions:
Our study shows that CACS can accurately predict SCAS in a large proportion of pre-kidney and liver transplant patients with intermediate or high risk of coronary artery disease. CACS can be considered as a screening tool to identify patients with low likelihood of SCAS, who might not require CCTA, as well as those with a high likelihood in whom a proactive approach should be considered.
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