Coronary revascularization in patients with liver cirrhosis

Ann Thorac Surg. 2011 May;91(5):1393-9. doi: 10.1016/j.athoracsur.2011.01.022. Epub 2011 Mar 10.


Background: Liver cirrhosis is a major risk factor for cardiac surgery using cardiopulmonary bypass. However, percutaneous coronary intervention (PCI) or off-pump coronary artery bypass graft surgery (OPCABG) may be a less invasive alternative strategy.

Methods: Among the 9,877 patients undergoing first PCI or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 332 patients diagnosed with liver cirrhosis were entered into the study (age 67.1±9.4 years; 246 male). Liver cirrhosis was diagnosed by liver biopsy or signs of portal hypertension with characteristic morphologic liver and spleen changes.

Results: A total of 233 patients received PCI, 58 conventional on-pump CABG (CCABG), and 41 OPCABG. Median follow-up was 3.3 years. The PCI group included less complex coronary lesions such as triple vessel and left main disease (p<0.01 each). Propensity score adjusted in-hospital mortality after CCABG or OPCABG was higher than that after PCI; however, the differences were not significant (odds ratio [95% confidence interval]: 6.84 [0.52 to 90.8], p=0.14 for CCABG versus PCI; and 1.86 [0.08 to 45.8], p=0.71 for OPCABG versus PCI). Adjusted overall mortality after CCABG or CABG was lower than that after PCI, but the differences were not significant (0.66 [0.31 to 1.40], p=0.28; and 0.64 [0.28 to 1.49], p=0.31, respectively). Approximately two thirds of patients died of noncardiovascular morbidities (malignancies, including hepatocarcinoma, or hepatic decompression).

Conclusions: Because overall noncardiovascular mortality is high among patients with liver cirrhosis, complete revascularization may not be associated with better survival outcomes. Further study is warranted to determine the impact of a coronary revascularization strategy for liver cirrhosis patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon, Coronary / methods
  • Angioplasty, Balloon, Coronary / mortality
  • Biopsy, Needle
  • Cohort Studies
  • Coronary Artery Bypass / methods
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass, Off-Pump / methods
  • Coronary Artery Bypass, Off-Pump / mortality
  • Coronary Stenosis / complications*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / surgery*
  • Female
  • Graft Rejection
  • Graft Survival
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology*
  • Liver Cirrhosis / surgery
  • Male
  • Middle Aged
  • Myocardial Revascularization / methods*
  • Myocardial Revascularization / mortality
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Radiography
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis
  • Treatment Outcome