Performing diagnostic coronary angiography to evaluate high-risk cardiac donors : A French nationwide cohort study
Copyright © 2018 Elsevier B.V. All rights reserved..
BACKGROUND: Allograft shortage might be overcome by the use of hearts from expanded-criteria donors (ECD) but their estimated high-risk of coronary artery disease (CAD) results in a limited utilization of these hearts for transplantation. We aimed to determine if performing coronary angiography (CA) in ECD enhances cardiac procurement and to develop a predictive model estimating their probability of absence of CAD.
METHODS: We retrospectively used the French National Transplant Registry CRISTAL and considered all donors aged 45 to 70 with ≥ 1 organ harvested between March 2012 and June 2014 to derive a high-risk donor population. Of 515 donors with ≥ 1 CAD risk factor and no obvious contraindication for cardiac procurement, 230 underwent CA. Coefficients estimated by multivariate logistic regression models were used to evaluate the impact of CA on procurement and build the predictive model.
RESULTS: Among CA donors, 133 had CAD, 53 (23%) with at least one stenosis ≥ 50%. Predictors of cardiac graft offer were female gender, age below 60, no cardiac arrest, no intravenous adrenaline/dobutamine requirement and no treated hypercholesterolemia. CA increased the probability of procurement by 9% (p = 0.028). Female gender, non-vascular cause of death, absence of diabetes and BMI ≥ 25 kg/m2 (p < 0.05) were associated with a normal CA and used for the prediction model. The area under the ROC curve of the model was 0.70. Specificity for the highest quartile was 82%.
CONCLUSION: Performing CA in ECD enhances cardiac procurement. When CA is not feasible, we defined a clinical score allowing accurate estimation of normal CA probability.
| Errataetall: |
CommentIn: Int J Cardiol. 2019 Feb 15;277:104-105. - PMID 30309684 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:277 |
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| Enthalten in: |
International journal of cardiology - 277(2019) vom: 15. Feb., Seite 71-78 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ivanes, Fabrice [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary angiography |
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| Anmerkungen: |
Date Completed 03.09.2019 Date Revised 03.09.2019 published: Print-Electronic CommentIn: Int J Cardiol. 2019 Feb 15;277:104-105. - PMID 30309684 Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2018.08.003 |
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| PPN (Katalog-ID): |
NLM287287386 |
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| 100 | 1 | |a Ivanes, Fabrice |e verfasserin |4 aut | |
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| 500 | |a Date Revised 03.09.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Int J Cardiol. 2019 Feb 15;277:104-105. - PMID 30309684 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: Allograft shortage might be overcome by the use of hearts from expanded-criteria donors (ECD) but their estimated high-risk of coronary artery disease (CAD) results in a limited utilization of these hearts for transplantation. We aimed to determine if performing coronary angiography (CA) in ECD enhances cardiac procurement and to develop a predictive model estimating their probability of absence of CAD | ||
| 520 | |a METHODS: We retrospectively used the French National Transplant Registry CRISTAL and considered all donors aged 45 to 70 with ≥ 1 organ harvested between March 2012 and June 2014 to derive a high-risk donor population. Of 515 donors with ≥ 1 CAD risk factor and no obvious contraindication for cardiac procurement, 230 underwent CA. Coefficients estimated by multivariate logistic regression models were used to evaluate the impact of CA on procurement and build the predictive model | ||
| 520 | |a RESULTS: Among CA donors, 133 had CAD, 53 (23%) with at least one stenosis ≥ 50%. Predictors of cardiac graft offer were female gender, age below 60, no cardiac arrest, no intravenous adrenaline/dobutamine requirement and no treated hypercholesterolemia. CA increased the probability of procurement by 9% (p = 0.028). Female gender, non-vascular cause of death, absence of diabetes and BMI ≥ 25 kg/m2 (p < 0.05) were associated with a normal CA and used for the prediction model. The area under the ROC curve of the model was 0.70. Specificity for the highest quartile was 82% | ||
| 520 | |a CONCLUSION: Performing CA in ECD enhances cardiac procurement. When CA is not feasible, we defined a clinical score allowing accurate estimation of normal CA probability | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Coronary angiography | |
| 650 | 4 | |a Coronary artery disease | |
| 650 | 4 | |a Donor screening | |
| 650 | 4 | |a Heart transplantation | |
| 650 | 4 | |a Risk assessment | |
| 700 | 1 | |a Cantrelle, Christelle |e verfasserin |4 aut | |
| 700 | 1 | |a Genet, Thibaud |e verfasserin |4 aut | |
| 700 | 1 | |a Le Feuvre, Claude |e verfasserin |4 aut | |
| 700 | 1 | |a Legeai, Camille |e verfasserin |4 aut | |
| 700 | 1 | |a Jasseron, Carine |e verfasserin |4 aut | |
| 700 | 1 | |a Pipien, Isabelle |e verfasserin |4 aut | |
| 700 | 1 | |a Epailly, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Bastien, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Angoulvant, Denis |e verfasserin |4 aut | |
| 700 | 1 | |a Dorent, Richard |e verfasserin |4 aut | |
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