RT Journal Article
T1 Clinical Utility of a Risk-Adapted Protocol for the Evaluation of Coronary Artery Disease in Liver Transplant Recipients
T2 Clinical Utility of a Risk-Adapted Protocol for the Evaluation of Coronary Artery Disease in Liver Transplant Recipients
A1 Romero Cristóbal, Mario
A1 Mombiela Remirez de Gamuza, Teresa
A1 Caballero, Aranzazu
A1 Fernández Yunquera, Ainhoa
A1 Díaz Fontenla, Fernando
A1 Rincón Rodríguez, Diego
A1 Ripoll, Cristina
A1 Bermejo Thomas, Francisco Javier
A1 Vega Catalina, María
A1 Matilla, Ana María
A1 Ibañez Samaniego, Luis
A1 Pérez Peña, José
A1 López Baena, José Ángel
A1 Díaz Zorita, Benjamín
A1 Fernández-Avilés Díaz, Francisco Jesús
A1 Salcedo Plaza, María Magdalena
A1 Bañares Cañizares, Rafael
AB The prevalence and management of coronary artery disease (CAD) in liver transplantation (LT) candidates are not well characterized. The aims of this study were to evaluate the impact on clinical outcomes of a specifically designed protocol for the management of asymptomatic CAD in LT candidates and to investigate noninvasive risk profiles for obstructive and nonobstructive CAD for 202 LT candidates. Those with high baseline cardiovascular risk (CVR; defined by the presence of classic CVR factors and/or decreased ejection fraction) received coronary angiography and significant arterial stenosis and were treated with percutaneous stents. Patients were followed up after LT until death or coronary event (CE). There were 78 patients who received coronary evaluation (62 direct angiography, 14 computed tomography coronary angiography, and 2 both). Of them, 39 (50%) patients had CAD of any severity, and 6 (7.7%) had significant lesions (5 were amenable to be treated with stents, whereas 1 patient had diffuse lesions which contraindicated the LT). Insulin-dependent diabetes was the only factor related to CAD of any severity (odds ratio, 3.44; 95% confidence interval [CI], 1.00-11.97). A total of 69 patients (46 with coronary evaluation) received LT. The incidence of CEs and overall survival after LT were similar between patients with and without coronary evaluation. Furthermore, no differences occurred between these groups in a multivariate competing risk model (subhazard ratio, 0.84; 95% CI, 0.27-2.61; P = 0.76). In conclusion, the application of an angiographic screening protocol of CAD in a selected high-risk Mediterranean population is safe and effective. The short- and medium-term incidence rates of CEs and death after LT in this population are similar to that observed in low-risk patients.
PB Wiley
SN 1527-6465
YR 2019
FD 2019-08-08
LK https://hdl.handle.net/20.500.14352/98616
UL https://hdl.handle.net/20.500.14352/98616
LA eng
NO Romero‐Cristóbal, Mario1; Mombiela, Teresa2,5; Caballero, Aranzazu1; Clemente, Ana1; Fernández‐Yunquera, Ainhoa1; Diaz‐Fontenla, Fernando1; Rincón, Diego1,6,8; Ripoll, Cristina7; Bermejo, Javier2,5; Catalina, María‐Vega1; Matilla, Ana‐María1; Ibáñez‐Samaniego, Luis1; Pérez‐Peña, José3; López‐Baena, José‐Ángel4; Díaz‐Zorita, Benjamín4; Fernández‐Avilés, Francisco2,5,8; Salcedo, M. Magdalena1,6,8; Bañares, Rafael*,1,6,8. Clinical Utility of a Risk‐Adapted Protocol for the Evaluation of Coronary Artery Disease in Liver Transplant Recipients. Liver Transplantation 25(8):p 1177-1186, August 2019. | DOI: 10.1002/lt.25493
NO Este estudio, en el cual el solicitante es autor senior (útimo autor), estuvo encaminado a determinar si un protocolo de evaluación de enfermedad coronaria adaptado al riesgo basal en pacientes receptores de trasplante hepático, era capaz de atenuar el riesgo de enfermedad coronaria y en la supervivencia de pacientes trasplantados. El resultado fundamental de este estudio prospectivo fue que este protocolo (que comprende una evaluacion escalonada de la anatomía coronaria con intervenciones terapéuticas adaptadas) iguala la probabilidad de eventos cardiovasculares postrasplante con respecto a los pacientes de bajo riesgo. La aplicabilidad de este estudio es grande puesto que permite de forma protocolizada y adaptada a cada paciente la valoracion precisa del riesgo coronario, evitando exploraciones agresivas.
DS Docta Complutense
RD 8 abr 2025