CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates

Rachwan, Rayan Jo; Kutkut, Issa; Timsina, Lava; Chaaya, Rody G. Bou; El-Am, Edward; Sabra, Mohammad; Mshelbwala, Fakilahyel S.; Rahal, Mahmoud; Lacerda, Marco A.; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Ghabril, Marwan; Bourdillon, Patrick D.V.; Mangus, Richard S.

doi:10.1016/j.jhep.2021.01.008

Cited by 29 publications

(18 citation statements)

References 27 publications

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“…With the gradual increase in median age of the waitlist LT candidates and the rising indication of NASH for LT, (33,34) there is a pressing need to ensure adequate evaluation and optimization of LT candidates with CAD. Nearly 1 in 6 potential LT waitlist registrants have CAD, with the highest prevalence found in studies originating from North America with a high prevalence of obesity.…”

Section: Discussionmentioning

confidence: 99%

A Meta‐Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients

Xiao

Yong

et al. 2021

Liver Transpl

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The shift in the changing etiology of cirrhosis requiring liver transplantation (LT) has resulted in an increasing prevalence of coronary artery disease (CAD) that can potentially impact post‐LT outcomes. This systematic review and meta‐analysis evaluates the prevalence of CAD, risk factors, and outcomes of patients diagnosed with CAD before LT. MEDLINE and EMBASE were searched for articles describing CAD in pre‐LT patients. Meta‐analysis of proportions using the generalized linear mix model was conducted to analyze the pooled prevalence of CAD in pre‐LT patients. Associated risk factors for CAD in pre‐LT patients and outcomes were evaluated in conventional pairwise meta‐analysis. A total of 39 studies were included. The pooled prevalence of patients diagnosed with CAD before LT was 15.9% (95% CI, 9.8%‐24.7%). Age, male sex, diabetes mellitus, hypertension, hyperlipidemia, smoking, nonalcoholic steatohepatitis, hepatitis B virus, and hepatocellular carcinoma were significantly associated with CAD. Patients from high‐income countries especially North America, Europe, and South America, with the associated risk factors were at increased risk for CAD before LT. CAD before LT was associated with an increased odds of overall mortality (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.4‐1.4; P = 0.01) and cardiac‐related mortality (OR, 1.2; 95% CI, 1.1‐1.3; P = 0.03). A total of 48.7% of included articles considered the presence of cardiovascular risk factors for CAD screening. However, 10.3% of the studies screened for CAD in pre‐LT patients via invasive coronary angiography only, without stress testing or risk stratification. This study demonstrates the high prevalence of CAD in pre‐LT patients, associated risk factors, and outcomes. There is heterogeneity among guidelines and practice in screening for pre‐LT CAD, and more studies are needed to establish consensus.

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Section: Discussionmentioning

confidence: 99%

A Meta‐Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients

Xiao

Yong

et al. 2021

Liver Transpl

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“…107 The Coronary Artery Disease in Liver Transplantation score 107a predicts significant (eg, obstructive) CHD (internal cross-validation C statistic, 0.76). 108 The Coronary Artery Disease in Liver Transplantation authors also derived a clinical algorithm to guide cardiac evaluation, which detected CAD with a high sensitivity (97%) when applied retrospectively to 1226 liver transplantation candidates at their institution. It is notable that the analysis suggests that 561 patients could have avoided ICA if the Coronary Artery Disease in Liver Transplantation algorithm had been used.…”

Section: Chd Screening Strategies For Liver Transplantation Candidatesmentioning

confidence: 99%

Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association

Cheng¹,

VanWagner²,

Costa³

et al. 2022

Circulation

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Coronary heart disease is an important source of mortality and morbidity among kidney transplantation and liver transplantation candidates and recipients and is driven by traditional and nontraditional risk factors related to end-stage organ disease. In this scientific statement, we review evidence from the past decade related to coronary heart disease screening and management for kidney and liver transplantation candidates. Coronary heart disease screening in asymptomatic kidney and liver transplantation candidates has not been demonstrated to improve outcomes but is common in practice. Risk stratification algorithms based on the presence or absence of clinical risk factors and physical performance have been proposed, but a high proportion of candidates still meet criteria for screening tests. We suggest new approaches to pretransplantation evaluation grounded on the presence or absence of known coronary heart disease and cardiac symptoms and emphasize multidisciplinary engagement, including involvement of a dedicated cardiologist. Noninvasive functional screening methods such as stress echocardiography and myocardial perfusion scintigraphy have limited accuracy, and newer noninvasive modalities, especially cardiac computed tomography–based tests, are promising alternatives. Emerging evidence such as results of the 2020 International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease trial emphasizes the vital importance of guideline-directed medical therapy in managing diagnosed coronary heart disease and further questions the value of revascularization among asymptomatic kidney transplantation candidates. Optimizing strategies to disseminate and implement best practices for medical management in the broader end-stage organ disease population should be prioritized to improve cardiovascular outcomes in these populations.

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“…5,8 In this issue of the Journal of Hepatology, Rachwan et al from the Indiana University Medical School propose the use of the "CAD-LT score" and the derived algorithm with the aim to predict the risk of significant CAD in LT candidates, with potential benefits in terms of safety, efficacy and cost savings. 15 This retrospective study assessed clinical characteristics, aetiology of ESLD, MELD (model for end-stage liver disease) score, cardiac risk factors, stress echocardiography (SE) and coronary artery catheterisation (CATH) findings in 1,771 LT candidates over a 10-year period. The CAD-LT score included risk factors (age, male gender, diabetes, hypertension, tobacco use, family history of CAD and personal history of CAD) that independently predicted significant CAD on CATH, defined as stenosis > − 50 in a major vessel or > − 70% in a moderate-sized branch vessel, on multivariate regression analysis.…”

mentioning

confidence: 99%

“…First, according to clinical practice in their centre, Rachwan et al 15 set a very low threshold to prescribe SE and CATH. Indeed, 92% of LT candidates underwent SE and 71% CATH.…”

mentioning

confidence: 99%

“…18 It is the ability of a coronary artery lesion to cause myocardial ischaemia rather than the degree of stenosis, as assessed visually by CATH, that really influences peri-and post-operative adverse events. The CAD-LT score proposed by Rachwan et al 15 aims to estimate the probability of anatomically defined significant CADwhether implementation of such an algorithm impacts on peri-LT outcomes remains to be established. It is noteworthy that a previous study from the Indiana University Medical School reported on the outcome of a smaller group of LTRs who underwent pre-operative CATH or not according to the presence of coronary risk factors.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cardiac evaluation before liver transplantation: A step forward?

Gasperi

Zorzi

2021

Journal of Hepatology

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CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates

Cited by 29 publications

References 27 publications

A Meta‐Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients

A Meta‐Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients

Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association

Cardiac evaluation before liver transplantation: A step forward?

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