A comprehensive review of coronary artery disease in patients with end-stage liver disease

The prevalence of coronary artery disease has increased in patients with end stage liver disease. In the near future, non-alcoholic steatohepatitis is expected to be the leading cause of end stage liver disease and shares common risk factors with coronary artery disease such as hypertension, hyperlipidemia, obesity and diabetes mellitus. At present, liver transplantation is the only definitive treatment for end stage liver disease, with post-operative mortality associated with the presence of coronary artery disease. Given the high prevalence of cardiovascular disease and the unique balance of pro-thrombotic and antithrombotic factors in patients with end stage liver disease, we sought to discuss the non-invasive and invasive diagnosis, medical and procedural management considerations and pre-transplant evaluation of coronary artery disease in patients with end stage liver disease. •Coronary artery disease is becoming more prevalent in patients with ESLD.•Coronary artery disease decreases orthotropic liver transplantation survival.•Non-invasive screening tests have limitations in patients with ESLD.•ESLD confers higher risk of cardiac catheterization complications.•We present an algorithm for coronary artery disease evaluation in ESLD.