Abstract 15844: Predicting the Risk of Significant Coronary Artery Disease in Liver Transplant Patients: The CAD-LT Score

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rayan Jo Rachwan ◽  
Issa Kutkut ◽  
Lava R Timsina ◽  
Rody G Bou Chaaya ◽  
Edward El-Am ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Liver Transplant ◽  
Risk Group ◽  
Significant Coronary Artery Disease ◽  
Receiver Operating Curve ◽  
Smoking History ◽  
History Of ◽  
Artery Disease

Background: Patients with significant coronary artery disease (CAD) are more likely to develop post-liver transplant (LT) cardiac events. We developed the CAD-LT screening score and testing algorithm to predict the risk of significant CAD in LT candidates. Methods: Patients who underwent pre-LT evaluation at Indiana University (2010-2017) were studied retrospectively (n=1814). Stress tests (ST) (n=1677) and cardiac catheterization (CATH) reports (n=1300) were reviewed. CATH was performed in patients with predefined CAD risk factors. Significant CAD was defined as disease requiring percutaneous or surgical intervention. Multivariable estimates (Adjusted Odds Ratio i.e. AOR [95%CI]) with assessment of model performance using Receiver Operating Curve analysis were used to compute a point-based risk score and stratify patients. A 10-fold internal cross-validation (CV) model was done. Results: There were 950 LT and 864 no-LT patients. The risk-adjusted predictors of significant CAD were older age (AOR 1.06 [95%CI 1.03-1.09]), male gender (1.69 [1.13-2.50]), diabetes (1.44 [1.01-2.06]), hypertension (1.50 [1.05-2.15]), current smoking history (1.81 [1.16-2.82]), family history of CAD (1.76 [1.24-2.50]), and personal history of CAD (5.41 [3.48-8.43]). The CAD-LT score is shown in Table 1. Figure 1 is an algorithm for its use. The mean CV Area Under the Curve [95% CI] was 0.75 [0.71-0.79]. The algorithm detected 97% of the patients with significant CAD and would decrease the number of ST by 718 (43%; 671 in high-risk group and 47 in low-risk group) and CATH by 409 (30%). Conclusion: The CAD-LT score identifies LT candidates at high risk for significant CAD and guides pre-LT testing.

Screening for significant coronary artery disease in high-risk renal transplant candidates

2007 ◽  
Vol 18 (7) ◽  
pp. 553-558 ◽  
Author(s):  
Luís Henrique W. Gowdak ◽  
Flávio J. de Paula ◽  
Luiz Antonio M. César ◽  
Eulógio E. Martinez Filho ◽  
Luiz Estevan Ianhez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Renal Transplant ◽  
Significant Coronary Artery Disease ◽  
Artery Disease ◽  
Transplant Candidates

P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S E Lee ◽  
G Pontone ◽  
I Gottlieb ◽  
M Hadamitzky ◽  
J A Leipsic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Obstructive Coronary Artery Disease ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Obstructive Lesion ◽  
History Of ◽  
Artery Disease

Abstract Background It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP. Purpose We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP. Methods Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05). Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use. Conclusion The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline. Acknowledgement/Funding This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

Abstract 1528: Gender Differences In The Effect Of Traditional Cardiac Risk Factors On Age At Presentation With Stemi

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
William Herzog ◽  
Thomas Aversano
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Female Gender ◽  
Smoking History ◽  
Men And Women ◽  
History Of ◽  
Males And Females ◽  
Artery Disease

For coronary artery disease (CAD), female gender is ’protective’, so that women typically present with clinically apparent CAD a decade later than men. We examined the extent to which traditional cardiovascular risk factor influence the age at presentation with STEMI in men and women. The Cardiovascular Patient Outcomes Research Team (C-PORT) primary PCI registry includes 7197 patients (5070 males and 2109 females) who presented with STEMI at 33 participating hospitals. The table below depicts the average age at presentation with STEMI in males and females with and without diabetes, hypercholesterolemia, hypertension, a family history of coronary artery disease and smoking history (current or former). The effect of smoking, family history and hypertension on age at presentation remained significant in multivariate analysis in both men and women. In both males and females, a family history of CAD and a positive smoking history are associated with presentation with STEMI at a younger age. Both have a greater effect in females. This is particularly true of smoking with lowers the age of presentation by 9 years in women, compared with 3.8 years in men. Male and female patients with a history of hypertension are older at presentation with STEMI, perhaps because the anti-ischemic effects of anti-hypertensive medications. We conclude that while the effect of most traditional risk factors for CAD on age at presentation with STEMI are similar in men and women, smoking lowers the age at presentation to a much greater degree in women. In women who do not smoke, STEMI is delayed for a decade or more compared to men; for women who do, the protective effect of female gender is nearly obliterated.

213 HISTORY OF CORONARY ARTERY DISEASE PREDICTS INFERIOR SURVIVAL IN LIVER TRANSPLANT RECIPIENTS OF ADVANCED AGE IN A LARGE MULTICENTER U.S. COHORT

2020 ◽  
Vol 158 (6) ◽  
pp. S-1261
Author(s):  
Margarita N. German ◽  
Alexander Hristov ◽  
Alexander S. Lee ◽  
Fauzia Osman ◽  
Allison J. Kwong ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Liver Transplant ◽  
Advanced Age ◽  
Transplant Recipients ◽  
History Of ◽  
Artery Disease ◽  
Liver Transplant Recipients

scholarly journals Role of Coronary Calcium Score as a Screening Tool for Excluding Significant Coronary Artery Disease in High Risk Asymptomatic Patients

2022 ◽  
Vol 9 (1) ◽  
pp. 64-68
Author(s):  
Fariha Afzal ◽  
Muhammad Imran Khan ◽  
Zenab
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Screening Tool ◽  
Coronary Artery Stenosis ◽  
Significant Coronary Artery Disease ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Artery Disease ◽  
Zero Calcium Score

OBJECTIVES: To determine correlation of zero coronary artery calcium score (CACS) with non-significant coronary artery stenosis by using computed tomography coronary angiography (CTCA). METHODOLOGY: 62 patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA from April 2018 to November 2020. Patients were examined with 160 slice multidetector CT and grouped according to their age, gender, CACS, and maximum coronary luminal stenosis. CACS was assessed using Agatston scoring and degree of stenosis was assessed by automatic software and severity was scored according to CAD-RADS. The correlation between these two main variables was calculated using Spearman rank correlation. RESULTS: The 62 patients were divided into four groups according to CACS, using the Agatston Unit (AU). Group 1; 0 AU (41 patients, 66.13%), Group 2; 1-100 AU (13 patients, 20.97%) Group 3; 101-400 AU (4 patients, 6.45%), Group 4; 401-1000 AU (4 patients, 6.45%). In 41 patients with zero calcium score (32 males and 9 females), 38 patients (92.68%) were found to have no coronary artery stenosis, 2 patients (4.87%) had mild coronary artery stenosis and 1 patient (2.43%) had moderate coronary artery stenosis. Total 35 patients presented for screening purpose out of which 25 (71%) had zero calcium score and no significant coronary artery disease. CONCLUSION: In high risk patients, zero calcium score excludes significant coronary artery stenosis (50%), hence coronary calcium score is a good screening tool before subjecting patients to coronary angiography.

Abstract 77: Statin Adherence and Persistence Among Japanese Patients With High Risk Vascular Disease: A Japan Claims Database Analysis

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Zhenxiang Zhao ◽  
Patrick L McCollam ◽  
Keith L Davis ◽  
Juliana Meyers ◽  
Masahiro Murakami
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Baseline Period ◽  
Claims Database ◽  
History Of ◽  
Artery Disease ◽  
Statin Adherence ◽  
Statin Use

BACKGROUND: High risk vascular disease (HRVD defined as cerebrovascular disease [CVD], coronary artery disease with diabetes [CADD], history of acute coronary syndrome [ACS], or peripheral artery disease [PAD]) is among the biggest health problems affecting Japanese, with CVD and coronary artery disease (CAD) being the 2nd and 3rd most common causes of death. Despite proven efficacy of statins in reducing CV mortality, limited research is available to systematically study statin adherence and persistence for HRVD patients in Japan. OBJECTIVE: Examine statin adherence and persistence in HRVD patients. METHOD: A retrospective cohort study was conducted using the Japan Medical Data Center (JMDC) database, a large Japanese administrative claims database with 10 insurance societies (payers), and integrated inpatient, outpatient, and pharmacy claims of approximately 0.8 million covered lives from 2006-2011. Patients > 18 years with HRVD (CVD, PAD, CADD or history of ACS [≥30days through 365 days after discharge for ACS]) between 01/01/2008 to 12/31/2009, were identified for this study with minimum 12-month pre- and 24-month post-index insurance eligibility. Statin use was measured during the 12-month baseline period and the 24-month follow-up period. The date of the first HRVD claim(s) satisfying the above inclusion criteria was defined as the index date. Statin use was examined for the overall HRVD group as well as subgroups of patients with CVD only, PAD only, CADD only, history of ACS only, and patients with multiple HRVDs. Statin adherence, calculated using the medication possession ratio [MPR], and statin persistence, assessed with survival analysis techniques using a ≥30-day gap to define discontinuation, were measured in the 24-month follow-up period for the overall HRVD patient group. RESULTS: There were 10,400 HRVD patients identified in the JMDC database. Mean age was 52.8 and 57.1% were male. Statin use during the baseline period showed 12.1% of HRVD patients taking statins (CVD only: 10.2%; PAD only: 9.6%; CADD only: 14.6%; history of ACS only: 46.7%; CADD and a history of ACS: 48.3%; 2 affected artery beds: 17.8%; 3 affected artery beds: 19.5%). Statin use increased to 32.9% during the 24-month follow-up period (CVD only: 27.6%; PAD only: 26.6%; CADD only: 45.1%; history of ACS only: 54.4%; CADD and a history of ACS: 58.3%; 2 affected artery beds: 49.3%; 3 affected artery beds: 45.5%). For Japanese HRVD patients who used a statin, mean/median MPR was 0.89/0.94 and 82.1% of statin users were adherent (MPR ≥80%) to their statin therapy during the 24-month follow up period. The median time to statin discontinuation was 679 days during the 24-month follow up period. CONCLUSION: Statin use after HRVD diagnosis was modest and highest in ACS patients and patients with multiple affected vascular beds. Statin adherence was high among patients with HRVD in Japan.

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