University of Alabama at Birmingham Birmingham, AL, United States
Joseph W. Granade, MD, Mohamed Shoreibah, MD, Mahmoud Aryan, MD, Nishah Panchani, MD, Yassmin Hegazy, MD, Lindsey Shipley, MD, Stewart Herndon, MD, Abirami Thiyagarajan, MD, Meagan Reif, MD University of Alabama at Birmingham, Birmingham, AL
Introduction: As the prevalence of non-alcoholic fatty liver disease (NAFLD) continues to rise, the evaluation of coronary artery disease (CAD) represents an increasingly crucial area of research given coronary events are the most common cause of mortality before and after liver transplantation (LT) among patients with NAFLD. Despite guideline recommendations for formal cardiac evaluation prior to LT, there is little data on the utility of invasive cardiac. Our aim was to study the one-year outcomes of patients based on coronary lesion grading.
Methods: We performed a retrospective review of all adult patients with cirrhosis who underwent left heart catheterization (LHC) as part of evaluation for LT between 2010 and 2020 at our institution.
Results: Of the 568 patients who underwent left heart catheterization prior to LT, only 294 (52%) went on to eventually receive LT and of those patients 134 (46%) were found to have some degree of CAD prior to transplant. Mild CAD was found in 107 patients, moderate CAD in 19, and 8 had severe CAD. Successful PCI was performed in 8 while only 4 underwent CABG. NAFLD was the leading etiology of cirrhosis in those with CAD as it accounted for 55% followed by alcohol at 23%. Males accounted for 71%. Mean age was 60.5 with mean BMI of 30.8 and mean of MELD 18.5. The rate of myocardial infarction (MI) within 1-year differed significantly by CAD grade: 2 patients in the mild group (1.87%), 2 patients in the moderate group (10.53%), and 1 patient in the severe group (12.5%) (p-value 0.02). Given an odds ratio of 6.6 (95% CI: 1.0, 41.5), patients with CAD grade > 1 were six times more likely to experience MI within one year of LT. Despite this increased risk of MI, there was no significant difference between all-cause mortality, cardiac arrest, arrythmia, or stroke between the different grades of CAD.
Discussion: As the prevalence of NAFLD rises, cardiac-related events will also become increasingly more common. No guidelines are currently available to guide decision-making regarding the severity of coronary lesions regarding LT. Our study shows a statistically significant increase in the rate of post-LT myocardial infarction in patients with higher CAD grades. Interestingly, this finding did not correlate with one-year survival, which did not vary significantly between CAD grades. Further studies are needed to better elucidate the utility of invasive coronary evaluation in improving patient outcomes.
Disclosures:
Joseph Granade indicated no relevant financial relationships.
Mohamed Shoreibah indicated no relevant financial relationships.
Mahmoud Aryan indicated no relevant financial relationships.
Nishah Panchani indicated no relevant financial relationships.
Yassmin Hegazy indicated no relevant financial relationships.
Lindsey Shipley indicated no relevant financial relationships.
Stewart Herndon indicated no relevant financial relationships.
Abirami Thiyagarajan indicated no relevant financial relationships.
Meagan Reif indicated no relevant financial relationships.
Joseph W. Granade, MD, Mohamed Shoreibah, MD, Mahmoud Aryan, MD, Nishah Panchani, MD, Yassmin Hegazy, MD, Lindsey Shipley, MD, Stewart Herndon, MD, Abirami Thiyagarajan, MD, Meagan Reif, MD. P2807 - Do Grades Really Matter? Effect of Coronary Artery Disease Grade on One-Year Survival Outcomes in Liver Transplant Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
