Prevalence and Prediction of Coronary Artery Disease in Patients with Liver Cirrhosis: A Registry-Based Matched Case Control Study
Background—There is conflict regarding the prevalence of coronary artery disease (CAD) in patients with liver cirrhosis (LC). This study aimed to investigate the prevalence of silent CAD compared with the general population, and to identify the relevant risk factors in LC patients.
Methods and Results—This retrospective study included 1,045 prospectively registered consecutive LC patients without any history of chest pain or CAD, who underwent computerized coronary angiography as a pre-transplant workup. These were matched with 6,283 controls with healthy livers, based on propensity scores according to established cardiovascular risk factors. Obstructive CAD was defined as 50% or more luminal narrowing in any artery. A matched analysis of 853 pairs showed that the proportion of subjects with obstructive CAD did not differ significantly between the cirrhotic and control groups (7.2% vs. 7.9%, P=0.646), in agreement with the outcome of multivariate analysis for its predictors, with an adjusted odds ratio (OR) for LC of 1.06 (P=0.690). Non-obstructive CAD was more prevalent in the matched cirrhotic cases (30.6% vs. 23.4%, P=0.001). In the pooled cirrhotic cohort, older age, male gender, hypertension, diabetes, and alcoholic cirrhosis were independently associated with obstructive CAD (adjusted ORs 1.07, 2.74, 1.69, 2.37, and 2.17, respectively; Ps<0.05 for all), whereas liver function and coagulation parameters were not.
Conclusions—Asymptomatic cirrhotic patients and non-hepatic subjects are similar in terms of the prevalence of occult obstructive CAD. Traditional cardiovascular risk factors are related to critical coronary stenosis in cirrhotic patients, and thus may be helpful indicators for more careful preoperative evaluation of coronary risk.
- Coronary artery stenosis
- Liver cirrhosis
- Computerized coronary angiography
- coronary artery disease
- coronary computed tomography angiography
- Received February 7, 2014.
- Revision received June 16, 2014.
- Accepted June 24, 2014.