Pre-Liver Transplant Coronary Artery Disease Workup for Low-Risk Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 976-980
Author(s):  
Jacentha Buggs ◽  
Sadaf Aslam ◽  
Chelsea Walker ◽  
Madison Hook ◽  
Tiffany M. Matyja ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Liver Transplant ◽  
Medical Records ◽  
Low Risk ◽  
Disease Assessment ◽  
Predictive Values ◽  
Risk Patients ◽  
Artery Disease

Background Coronary artery disease (CAD) is a leading cause of mortality following orthotopic liver transplant, yet there is no standardized protocol for pre-liver-transplant coronary artery disease assessment. The main objective of this study was to determine the agreement between 2 methods of cardiac risk assessment: dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) and to determine which test was best able to predict coronary calcification in low-risk patients. Methods A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. A total of 152 patients’ medical records were included based on the inclusion of patients who had received both DSE and CCS. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive values (PPVs) of both the CCS and DSE along with cardiac catheterization indicating abdominal occlusion were analyzed to compare the accuracy of the 2 tests. Results It was determined that there was a 12% agreement between DSE results and CCS. It was found that the DSE had a PPV of 56% and the CCS had a PPV of 80%. Conclusion From this data, it was concluded that there was no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the CCS had a much higher PPV and was therefore determined to be the more accurate test.

scholarly journals 990-52 Long-term Prognostic Significance of Treadmill Ischemia in “Low-risk” Patients with Coronary Artery Disease

1995 ◽  
Vol 25 (2) ◽  
pp. 313A
Author(s):  
David Mulcahy ◽  
Asif Rehman ◽  
Syed S. Husain ◽  
Neil P. Andrews ◽  
Gloria Zalos ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Significance ◽  
Low Risk ◽  
Risk Patients ◽  
Artery Disease

scholarly journals Sex differences in two international guidelines for assessing obstructive coronary artery disease in symptomatic outpatients by coronary computed tomographic angiography

2021 ◽  
Author(s):  
Yahang Tan ◽  
Zhe Wang ◽  
Qian Xin ◽  
Na Li ◽  
Fang Liu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Group ◽  
Obstructive Coronary Artery Disease ◽  
Low Risk ◽  
Noninvasive Testing ◽  
Nice Guidelines ◽  
Esc Guidelines ◽  
Artery Disease

Abstract Background Low-risk individuals are unlikely to benefit from noninvasive testing, and women tend to have a lower prevalence of obstructive coronary artery disease (CAD). This study compared the performance of two current guidelines that differ by sex to assess stable chest pain outpatients, including symptom-based (2016 National Institute for Health and Care Excellence, NICE) and risk-based strategies (2019 European Society of Cardiology, ESC). Methods A total of 542 men and women outpatients referred for coronary computed tomography angiography (CCTA) at a single-centre were retrospectively included in this study. A risk assessment was calculated for each outpatient according to the NICE and ESC guidelines. Patients were classified into low-risk and high-risk groups according to each strategy. The presence of obstructive coronary artery disease was the endpoint. Net reclassification improvement (NRI) was used to assess the performance of the two strategies. Results The 2016 NICE guidelines classified 29.39% of women and 34.60% of men into the low-risk group. The 2019 ESC guidelines classified 55.56% of women and 28.14% of men into the low-risk group. The 2019 ESC guidelines had a higher predictive value for coronary artery disease compared to the 2016 NICE guidelines, with a positive NRI in men (15.55%) and women (36.59%) respectively. Conclusion The 2019 ESC guidelines offered a more accurate calculation of risk assessment than the 2016 NICE guidelines. Patient sex influenced applying the recent ESC guidelines, which would result in a significant decrease in inappropriate testing of women but an increase in appropriate noninvasive testing of men.

Association of the Platelet Glycoprotein IIIa PIA1/A2 Gene Polymorphism to Coronary Artery Disease but not to Nonfatal Myocardial Infarction in Low Risk Patients

1998 ◽  
Vol 80 (08) ◽  
pp. 214-217 ◽  
Author(s):  
Jörg Humme ◽  
Jürgen Stricker ◽  
Quoc Nguyen ◽  
Norbert Katz ◽  
Monika Philipp ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Gene Polymorphism ◽  
Total Population ◽  
Low Risk ◽  
Platelet Glycoprotein ◽  
Risk Patients ◽  
Artery Disease ◽  
High Bmi

SummaryBackground. The platelet membrane glycoprotein IIb/IIIa functions as a receptor for fibrinogen and von Willebrand factor during platelet aggregation. In a small case-control study, evidence has been presented that the PlA2 allele of the platelet glycoprotein GPIIIa PlA1/A2 gene polymorphism might be an independent risk factor for acute myocardial infarction (MI). Methods and Results. We explored the association of the PlA1A2 to the severity of coronary artery disease (CAD), as assessed angiographically in 2252 male individuals, and to myocardial infarction (MI). The severity of coronary heart disease (CHD) was also estimated by calculating a CHD score according to Gensini. The PlA genotype was determined by allele specific restriction digestion. Relation of the PlA2 allele to CAD: In the total population, the frequency of the PlA2 allele was not associated to the presence or to the extent of CAD. Also the CHD scores of PlA1/PlA2 genotypes were essentially the same. However, after exclusion of individuals with high BMI (≥26.9 kg/m2) and/or low apoAI (<1.43 g/l) PlA2PlA2 carriers had clearly higher CHD scores than PlA1PlA1 genotypes; PlA1PlA2 heterozygotes had intermediate values (p <0.05). After division of the study population into one group of individuals without any angiographic signs of CAD (CHD score = 0) and into another group of patients with severe CAD (CHD score (≥120), a strong association of the PlA2 allele with severe CAD was also found in the same low risk groups; e.g. exclusion of persons with high BMI and low apoAI resulted in an Odds ratio of 5.37 (1.46-19.7) (p <0.02). Relation of the PlA2 allele to MI: No association was found between PlA1/PlA2 genotypes and risk of MI neither in the total population nor in low risk subgroups.Conclusions. Whereas no difference in the distribution of allele and genotype frequencies between controls and survivors of MI could be detected, the PlA2 allele is associated with CHD in low risk patients.

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