Divisions of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Richmond, VA.
Cardiology, Department of Internal Medicine, Richmond, VA.
Liver Transpl. 2018 Mar;24(3):333-342. doi: 10.1002/lt.25012.
Coronary artery disease (CAD) is an important contributor to morbidity and mortality in patients undergoing liver transplantation (LT). However, the current literature is limited by sampling bias and nondefinitive assessment of CAD. The current study examines the prevalence of CAD via per protocol coronary angiography and its relationship to etiology of liver disease in patients undergoing liver transplantation evaluation (LTE). Data on 228 patients were prospectively collected who had coronary angiography as part of LTE between 2011 and 2014. Coronary angiography was done in all patients age ≥50 years or with CAD risk factors. CAD was defined as any coronary artery stenosis, whereas stenosis ≥ 70% in distribution of 1 or 3 major coronary arteries was considered as single- or triple-vessel disease. CAD was detected in 36.8% of patients, with the highest prevalence among nonalcoholic steatohepatitis (NASH) patients with cirrhosis (52.8%). Prevalence of single-vessel disease was higher among patients with NASH compared with hepatitis C virus (HCV) and alcoholic cirrhosis (15.1% versus 4.6% versus 6.6%; P = 0.02). Similarly, patients with NASH were more likely to have triple-vessel disease when compared with HCV and alcoholic cirrhosis (9.4% versus 0.9% versus 0%; P = 0.001). While adjusting for traditional risk factors for CAD, only NASH as etiology of liver disease remained significantly associated with CAD. Complications from diagnostic coronary angiography or percutaneous coronary intervention were low (2.6%). In conclusion, patients undergoing LTE have a high prevalence of CAD, which varies widely depending on etiology of liver cirrhosis. The procedural complications from coronary angiography are low. Liver Transplantation 24 333-342 2018 AASLD.
冠状动脉疾病（CAD）是肝移植（LT）患者发病率和死亡率的重要原因。然而，目前的文献受到采样偏差和 CAD 非确定性评估的限制。本研究通过方案规定的冠状动脉造影检查了接受肝移植评估（LTE）患者 CAD 的患病率及其与肝病病因的关系。2011 年至 2014 年期间，前瞻性收集了 228 例接受冠状动脉造影检查作为 LTE 一部分的患者的数据。所有年龄≥50 岁或有 CAD 危险因素的患者均进行冠状动脉造影检查。CAD 定义为任何冠状动脉狭窄，而分布在 1 或 3 个主要冠状动脉中的狭窄≥70%则被认为是单支或三支血管病变。36.8%的患者检测到 CAD，其中肝硬化非酒精性脂肪性肝炎（NASH）患者的患病率最高（52.8%）。与丙型肝炎病毒（HCV）和酒精性肝硬化患者相比，NASH 患者单支血管疾病的患病率更高（15.1%比 4.6%比 6.6%；P=0.02）。同样，与 HCV 和酒精性肝硬化相比，NASH 患者更有可能患有三支血管疾病（9.4%比 0.9%比 0%；P=0.001）。在校正 CAD 的传统危险因素后，只有 NASH 作为肝病病因与 CAD 仍显著相关。诊断性冠状动脉造影或经皮冠状动脉介入治疗的并发症发生率较低（2.6%）。总之，接受 LTE 的患者 CAD 的患病率很高，其范围广泛，具体取决于肝硬化的病因。冠状动脉造影的程序并发症较低。肝移植 24 333-342 2018 AASLD。
