Risk stratification of myocardial injury after liver transplantation in patients with computed tomographic coronary angiography–diagnosed coronary artery disease

• Published in: American journal of transplantation Vol. 19; no. 7; pp. 2053 - 2066
• Main Authors: Moon, Young‐Jin, Kwon, Hye‐Mee, Jung, Kyeo‐Woon, Jeong, Hye‐Won, Park, Yong‐Seok, Jun, In‐Gu, Song, Jun‐Gol, Hwang, Gyu‐Sam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-07-2019
• Subjects: Angiography; Cardiovascular disease; clinical research/practice; Computed tomography; Coronary Angiography - methods; Coronary artery; coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary vessels; diagnostic techniques and imaging: coronary angiography; Female; Follow-Up Studies; Health risk assessment; Heart diseases; Heart failure; heart failure/injury; Humans; Liver transplantation; Liver Transplantation - adverse effects; liver transplantation/hepatology; Liver transplants; Male; Medical diagnosis; Medical imaging; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - etiology; Myocardial Infarction - pathology; Postoperative Complications - etiology; Postoperative Complications - pathology; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Risk Assessment - methods; Risk Factors; Tomography; Tomography, X-Ray Computed - methods; coronary artery disease; heart failure/injury; liver transplantation/hepatology; clinical research/practice; diagnostic techniques and imaging: coronary angiography
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15263

We aimed to determine if the severity of computed tomographic coronary angiography (CTCA)–diagnosed coronary artery disease (CAD) is associated with postliver transplantation (LT) myocardial infarction (MI) within 30 days and early mortality. We retrospectively evaluated 2118 consecutive patients who underwent CAD screening using CTCA. Post‐LT type‐2 MI, elicited by oxygen supply‐and‐demand mismatch within a month after LT, was assessed according to the severity of CTCA‐diagnosed CAD. Obstructive CAD (>50% narrowing, 9.2% prevalence) was identified in 21.7% of patients with 3 or more known CAD risk factors of the American Heart Association. Post‐LT MI occurred in 60 (2.8%) of total patients in whom 90‐day mortality rate was 16.7%. Rates of post‐LT MI were 2.1%, 3.1%, 3.4%, 4.3%, and 21.4% for normal, nonobstructive CAD, and 1‐, 2‐, and 3‐vessel obstructive CAD, respectively. Two‐vessel or 3‐vessel obstructive CAD showed a 4.9‐fold higher post‐LT MI risk compared to normal coronary vessels. The sensitivity and negative predictive value of obstructive CAD in detecting post‐LT MI were, respectively, 20% and 97.5%. In conclusion, negative CTCA finding in suspected patients can successfully exclude post‐LT MI, whereas proceeding with invasive angiography is needed to further risk‐stratify in patients with significant CTCA‐diagnosed CAD. Prognostic role of CTCA in predicting post‐LT MI needs further research.
Liver transplant recipients with noninvasive computed tomographic coronary angiography–diagnosed obstructive coronary artery disease and those with severe stenosis show occurrences of 6.2% and 8.9%, respectively, of post–liver transplant type 2 myocardial infarction, which results in 16.7% of 90‐day all‐cause mortality.