CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates
Rachwan RJ, Kutkut I, Timsina LR, Bou Chaaya RG, El-Am EA, Sabra M, Mshelbwala FS, Rahal MA, Lacerda MA, Kubal CA, Fridell JA, Ghabril MS, Bourdillon PD, and Mangus RS. CAD-LT score effectively predicts risk of significant coronary artery disease in liver transplant candidates. J Hepatol 2021.
Journal of hepatology
BACKGROUND AND AIMS: Patients with cirrhosis and significant coronary artery disease (CAD) are at risk for peri-liver transplantation (LT) cardiac events. The Coronary Artery Disease in Liver Transplantation (CAD-LT) score and algorithm aim to predict the risk of significant CAD in LT candidates and guide pre-LT cardiac evaluation.
METHODS: Patients who underwent pre-LT evaluation at Indiana University (2010-2019) were studied retrospectively. Stress echocardiography (SE) and cardiac catheterization (CATH) reports were reviewed. CATH was performed for predefined CAD risk factors, irrespective of normal SE. Significant CAD was defined as CAD requiring percutaneous or surgical intervention. A multivariate regression model was constructed to assess risk factors. Receiver Operating Curve analysis was used to compute a point-based risk score and a stratified testing algorithm.
RESULTS: A total of 1771 pre-LT patients underwent cardiac evaluation, including results from 1634 SE and 1266 CATH. Risk-adjusted predictors of significant CAD at CATH were older age (adjusted odds ratio 1.05 [95% confidence interval 1.03-1.08]), male gender (1.69 [1.16-2.50]), diabetes (1.57 [1.12-2.22]), hypertension (1.61 [1.14-2.28]), tobacco use (pack years) (1.01 [1.00-1.02]), family history of CAD (1.63 [1.16-2.28]), and personal history of CAD (6.55 [4.33-9.90]). The CAD-LT score stratified significant CAD risk as low (≤2%), intermediate (3% to 9%), and high (≥10%). Among patients who underwent CATH, a risk-based testing algorithm (Low: no testing; Intermediate: non-invasive testing vs. CATH; High: CATH) would have identified 97% of all significant CAD and potentially avoided unnecessary testing (669 SE [57%] and 561 CATH [44%]).
CONCLUSIONS: The CAD-LT score and algorithm (available at www.cad-lt.com) effectively stratify pre-LT risk for significant CAD. This may inform more targeted testing of candidates with fewer tests and faster time to waitlist.