Prognostic utility of coronary angiography in pre-operative cardiac evaluation for liver transplantation
Presenter
Anoshia Raza, MD, FSCAI, Rutgers New Jersey Medical School, Bloomfield, NJ
Anoshia Raza, MD, FSCAI1, Phillip Lim, MD2, Maciej Tysarowski, MD2, John Bertot, BS2, Paul Ippolito, BS2, Christine Gerula3, Alfonso Waller, MD2, Julius Gardin, MD, MBA2 and Marc Klapholz, MD, MBA, FSCAI2, (1)Rutgers New Jersey Medical School, Bloomfield, NJ, (2)Rutgers New Jersey Medical School, Newark, NJ, (3)Christine Marie Gerula, MD, Newark, NJ
Background:
Pre-operative cardiovascular evaluation of patients undergoing orthotopic liver transplantation (OLT) is crucial for risk stratification. The purpose of the study was to explore the prognostic utility of coronary angiography (CA) in the pre-OLT evaluation process.
Methods:
We conducted a retrospective review of 420 patients who underwent OLT at our tertiary care facility from August 2009 to August 2020. Of the 420 patients, 134 were referred for CA and stenoses were quantified. The primary outcome was a composite of all-cause mortality or major adverse cardiac events (MACE) - defined as new onset systolic heart failure, myocardial infarction, cardiac arrest, and stroke within 90 days of OLT.
Results:
There were 33 primary outcome events within 90 days of OLT in the entire cohort with 8 events in patients who underwent CA (Table 1). There were more primary outcome events in OLT patients with coronary stenoses > 50% (CS) (14%) compared to OLT patients with no CS (1.2%), (p = 0.008) (Table 2). In multivariate analysis (Figure 1), the presence of CS was independently associated with mortality or MACE (OR = 15.92 [95% CI 2.23 to 349.29], p = 0.020) after adjustment for age, gender, race, cardiovascular risk factors, and markers of liver failure.
Conclusions:
Recognition of CS is important in pre-OLT evaluation as it confers independent post-OLT prognostic value for 90-day all-cause mortality and MACE. 