Atherosclerosis on CT coronary angiography and risk of long-term cardiovascular events post liver transplantation.

Abstract

Computed tomography coronary angiography (CTCA) is increasingly utilized for pre-operative risk stratification prior to liver transplantation (LT). We sought to assess the predictors of advanced atherosclerosis on CTCA using the recently developed Coronary Artery Disease-Reporting and Data System (CAD-RADS) score and its impact on the prediction of long-term major adverse cardiovascular events (MACE) following LT. We conducted a retrospective cohort study of consecutive patients who underwent CTCA for LT work-up between 2011-2018. Advanced atherosclerosis was defined as coronary artery calcium scores (CACS) > 400 or CAD-RADS score ≥ 3 (≥ 50% coronary artery stenosis). Major adverse cardiovascular events were defined as myocardial infarction, heart failure, stroke or resuscitated cardiac arrest. Overall, 229 patients underwent CTCA (mean age 66 ± 5 y, 82% male). Of these, 157 (68.5%) proceeded with LT. The leading etiology of cirrhosis was hepatitis (47%), and 53% of patients had diabetes pre-transplant. On adjusted analysis, male sex (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.5-13.8, p = 0.006), diabetes (OR 2.2, 95%CI 1.2-4.2, p = 0.01) and dyslipidemia (OR 3.1, 95%CI 1.3-6.9, p = 0.005) were predictors of advanced atherosclerosis on CTCA. Thirty-two patients (20%) experienced MACE. At a median follow-up of 4-years, CAD-RADS ≥ 3, but not CACS, was associated with a heightened risk of MACE (HR 5.8, 95%CI 1.6-20.6, p = 0.006). Based on CTCA results, 71 patients (31%) commenced statin therapy which was associated with a lower risk of all-cause mortality (HR 0.48, 95%CI 0.24-0.97, p = 0.04). The standardized CAD-RADS classification on CTCA predicted the occurrence of cardiovascular outcomes following LT, with a potential to increase utilization of preventive cardiovascular therapies.