Su Amanda, Almazan Erik, Sakulsaengprapha Vorada, Shay Jessica, Wittstein Ilan, Hammami Muhammad, Pustavoitau Aliaksei, Rizkalla Nicole, Alqahtani Saleh, Woreta Tinsay, Hamilton James P, Kohli Ruhail, Ottmann Shane E, Gurakar Ahmet, Chen Po-Hung
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Transplant Direct. 2023 Jan 6;9(2):e1426. doi: 10.1097/TXD.0000000000001426. eCollection 2023 Feb.
Liver transplantation (LT) candidates frequently have multiple cardiovascular risk factors, and cardiovascular disease is a major cause of morbidity and mortality after LT. Coronary artery calcium (CAC) scores are a noninvasive assessment of coronary artery disease using computed tomography. This study examines CAC scores and cardiac risk factors and their association with outcomes after LT.
Patients who underwent LT between January 2010 and June 2019 with a pretransplant CAC score were included in this study. Patients were divided by CAC score into 4 groups (CAC score 0, CAC score 1-100, CAC score 101-400, CAC score >400). Major adverse cardiovascular events (MACEs) were defined as myocardial infarction, stroke, revascularization, heart failure, atrial fibrillation, and cardiovascular death. Associations between CAC score and MACE or all-cause mortality within the 5-y post-LT follow-up period were analyzed using Cox regression. Statistical significance was defined as < 0.05.
During the study period, 773 adult patients underwent their first LT, and 227 patients met our study criteria. The median follow-up time was 3.4 (interquartile range 1.9, 5.3) y. After 5 y, death occurred in 47 patients (20.7%) and MACE in 47 patients (20.7%). In multivariable analysis, there was no difference in death between CAC score groups. There was significantly higher risk of MACE in the CAC score >400 group, with a hazard ratio 2.58 (95% confidence interval 1.05, 6.29).
CAC score was not associated with all-cause mortality. Patients with CAC score >400 had an increase in MACEs within the 5-y follow-up period compared with patients with a CAC score = 0. Further research with larger cohorts is needed to examine cardiac risk stratification in this vulnerable patient population.
肝移植（LT）候选者通常有多种心血管危险因素，且心血管疾病是LT后发病和死亡的主要原因。冠状动脉钙化（CAC）评分是使用计算机断层扫描对冠状动脉疾病进行的无创评估。本研究探讨了CAC评分、心脏危险因素及其与LT后结局的关联。
本研究纳入了2010年1月至2019年6月期间接受LT且有移植前CAC评分的患者。患者按CAC评分分为4组（CAC评分为0、CAC评分为1 - 100、CAC评分为101 - 400、CAC评分>400）。主要不良心血管事件（MACE）定义为心肌梗死、中风、血运重建、心力衰竭、心房颤动和心血管死亡。使用Cox回归分析LT后5年随访期内CAC评分与MACE或全因死亡率之间的关联。统计学显著性定义为<0.05。
在研究期间，773例成年患者接受了首次LT，227例患者符合我们的研究标准。中位随访时间为3.4（四分位间距1.9，5.3）年。5年后，47例患者（20.7%）死亡，47例患者（20.7%）发生MACE。在多变量分析中，CAC评分组之间的死亡无差异。CAC评分>400组发生MACE的风险显著更高，风险比为2.58（95%置信区间1.05，6.29）。
CAC评分与全因死亡率无关。与CAC评分为0的患者相比，CAC评分>400的患者在5年随访期内MACE增加。需要对更大队列进行进一步研究，以检查这一脆弱患者群体的心脏风险分层。
