Performing diagnostic coronary angiography to evaluate high-risk cardiac donors: A French nationwide cohort study. (15th February 2019)

• Record Type: Journal Article
• Authors: Ivanes, Fabrice; Cantrelle, Christelle; Genet, Thibaud; Le Feuvre, Claude; Legeai, Camille; Jasseron, Carine; Pipien, Isabelle; Epailly, Eric; Bastien, Olivier; Angoulvant, Denis; Dorent, Richard
• Is Part Of: International journal of cardiology. Volume 277(2019)
• Page Start: 71
• Page End: 78
• Publication Date: 2019-02-15
• Subjects: Heart transplantation -- Donor screening -- Coronary angiography -- Coronary artery disease -- Risk assessment; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.08.003
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: 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/m 2 (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. Highlights: Coronary angiography in high-risk donors increased cardiac graft acceptance by 9%. We developed a normal coronary angiography prediction score with an 82% specificity. Coronary angiography should be performed in every expanded-criteria donor. If not, our normal coronary angiography prediction score is a valuable alternative.