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Introduction End stage liver disease (ESLD) is a highly morbid condition. While awaiting liver transplantation, many patients experience adverse events including cardiovascular events. Performing invasive cardiac procedures is a precarious undertaking given abnormal bleeding profiles that are common in this patient population. Revascularization options are challenging due to a need a potentially life changing operation, inability to tolerate dual antiplatelet therapy, and other comorbidities. Objective To examine the characteristics and outcomes of patients who are awaiting a liver transplant with ESLD who undergo cardiac catheterization at a University Medical Center. Methods We reviewed the medical records of all patients awaiting liver transplantation that were referred for cardiac catheterization between March 2006 and December 2010. We recorded demographic data, cardiac risk factors, relevant laboratories, results of their catheterization procedure and adverse events for the following year. Death from any cause within one year of the procedure, myocardial infarction, stroke, repeat revascularization, cardiac re-hospitalization and periprocedural bleeding were recorded as adverse events. Only patients with complete follow-up records were included. The MELD score, a common measurement of liver disease severity, was calculated at the time of initial referral Results Of the 440 charts reviewed, 18% (78) patients had a left heart catheterization. The demographics of the patients who had a left heart catheterization were women 35% (n=28), 50% (39) Caucasian, 21% (16) Black, 23% (18) Hispanic and 6% other. The average MELD score at the time of the procedure was 17, with the average platelet count 101. Cardiac risk factors were diabetes 59% (46), hyperlipidemia 13% (10) and hypertension. 30% (23) had radial access, while 70% (55) had femoral. 14% (n=11) underwent revascularization (7 PCI and 4 CABG). Complications for all patients undergoing cardiac catheterization included bleeding 26% (20) and death within one year 28% (22). Conclusion Patient with ESLD undergoing a cardiac catheterization have a higher rate of bleeding complications and death than patients who don’t have ESLD (26% versus <1%). Opportunities to decrease complications and mortality need to be further investigated in this patient population.

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Introduction Patients awaiting liver transplantation often have other comorbidities including coronary artery disease (CAD). Many patients undergo cardiac catheterization to diagnose and potentially treat CAD. However, patient with end stage liver disease (ESLD) are at risk for a host of complications and revascularization procedures are not commonly performed given this concern. The ability to predict which patient will experience a complication is not clearly defined. The MELD score is a composite measure used commonly in the hepatology community to quantify the severity of liver dysfunction. Methods We reviewed the medical records of all patients under consideration for liver transplantation between March 2006 and December 2010. We recorded demographic and laboratory data, cardiac risk factors and adverse events up to 1 year following cardiac catheterization. Adverse events included: all-cause death, myocardial infarction, stroke, repeat revascularization, cardiac re-hospitalization and periprocedural bleeding. Only patients with complete follow-up records were included. The MELD score, a common measurement of liver disease severity, was calculated at the time of initial referral. MELD scores were divided into tertiles. Results Among the 440 patients referred to the cath lab, 78 (18%) underwent coronary angiography. The mean age was 56 and 35% of the cohort were women. Minorities accounted for 49% of the population. The mean MELD score was 17. Nearly 51% of patients experienced at least one adverse event and 30% had multiple events. There was a non-significant trend towards an increased adverse event rate from the lowest to highest MELD score group. (42%, 46%, 70%, p=0.1) The overall mortality rate was 28%. Conclusion Patients with combined ESLD and coronary artery disease have an extremely high rate of adverse events following cardiac catheterization. Over half of the patients experienced an adverse event and nearly a third were dead at one year. The MELD score may be useful as a tool to predict the risk of having an adverse event in this complex patient population.