title: Role of cardiac catheterization and percutaneous coronary intervention in the preoperative assessment and management of patients before orthotopic liver transplantation.
abstract: Limited data regarding the optimal risk assessment strategy for evaluating candidates for orthotopic liver transplantation (OLT) exist. Our center has adopted a policy of performing cardiac catheterization (CATH) in patients with predefined risk factors, and this is followed by percutaneous coronary intervention (PCI) when it is indicated, even in the presence of negative stress test findings. The aim of this single-center, retrospective study of all patients who underwent OLT between 2000 and 2010 was to assess the effect of our policy on cardiovascular (CV) complications and survival rates after OLT. Data, including 1-year all-cause and CV mortality, postoperative myocardial infarctions (MIs), and frequencies of CATH and PCI, were abstracted. The study was divided into 3 subperiods to reflect the changes in policy over this period: (A) 2000-2004, (B) 2005-2008, and (C) 2009-2010. One thousand two hundred twenty-one patients underwent OLT between 2000 and 2010. The rate of catheterization increased during the 3 time periods (P < 0.001), as did the rate of PCI (P < 0.05). All-cause mortality decreased over the periods (P < 0.001), as did the MI rate (P < 0.001). Thirty-five of the 57 patients requiring PCI had normal stress tests. The mortality rate associated with postoperative MIs was significantly higher than the overall all-cause mortality rate. In conclusion, a significant improvement in the overall survival rate over the 3 analyzed time periods was noted. Increases in the frequencies of CATH and PCI corresponded to significant reductions in postoperative MIs and 1-year all-cause mortality rates. The increased use of CATH and PCI was associated with reduced overall all-cause mortality through reductions in the incidence of both fatal and nonfatal MIs. Further analyses of the role of stress testing and CATH in evaluating and treating patients before OLT are required to optimize this process.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN.
authors.forename: Haripriya
authors.initials: H
authors.lastname: Maddur
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Bourdillon
authors.forename: Suthat
authors.initials: S
authors.lastname: Liangpunsakul
authors.forename: A
authors.initials: A
authors.lastname: Joseph Tector
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghabril
authors.forename: Marco A
authors.initials: MA
authors.lastname: Lacerda
authors.forename: Charlotte
authors.initials: C
authors.lastname: Bourdillon
authors.forename: Changyu
authors.initials: C
authors.lastname: Shen
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Kwo
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007196:Indiana; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome