Coronary artery calcium (CAC) scoring has been extensively studied as a powerful, non-invasive tool for cardiovascular risk assessment in the general population. The aim of this study is to investigate whether CAC scoring could predict obstructive CAD in asymptomatic LT candidates with liver cirrhosis (LC). Methods: This study included 850 consecutive cirrhotic patients who underwent computerized coronary angi-ography with CAC measurement using
the Agaston method as a pre-LT workup. None of these patients had a previous CAD history. Obstructive CAD was Venetoclax defined as ≥50% of lumi-nal narrowing in any artery on computerized angiography. The association between CAC score and obstructive CAD was analyzed using the Pearson correlation method, logistic regression and area under the receiver operating characteristic Proteases inhibitor curve (AUROC) analyses. Results: The mean CAC score of all patients was 90.0 (range, 0-4411.4). The CAC score was 0 for 535 patients (62.9%), 1-100 for 191 (22.5%), 101-400 for 74 (8.7%), and >400 for 50 (5.9%). Obstructive
CAD was identified in 72 patients (8.5%). The mean CAC score significantly differed between patients with and without obstructive CAD (633.6 vs. 39.6; P<0.05). The prevalence of obstructive CAD increased with the CAC score (1.7% for 0, 5.8% for 1-100, 25.7% for 101-400, and 66.0% for >400). The CAC score was significantly correlated with the grade of coronary stenosis (r=0.71; P<0.05). The CAC score showed excellent performance for predicting obstructive CAD with an AUROC value of 0.88. The best cut-off CAC score was 38.8 for
obstructive CAD with a sensitivity of 83% and a specificity of 86%. In multivari-ate ADP ribosylation factor analysis, a CAC score at a cut-off of 38.8 was an independent predictor for obstructive CAD (adjusted odds ratio[OR], 23.9; P<0.05). Older age, male sex, a current smoker, hypertension, diabetes, and alcoholic LC were significantly associated with a CAC score above 38.8 (adjusted OR, 1.07, 3.27, 1.59, 1.54, 1.79, and 2.17; Ps<0.05), as were neither liver function and coagulation parameters nor viral hepatitis affect the score. Conclusion: Our data indicate that the CAC score is an accurate tool for predicting subclinical obstructive CAD in cirrhotic subjects. Traditional cardiovascular risk factors, together with alcoholic LC, were closely associated with higher CAC score.
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