Coronary risk stratification in patients with end-stage lung disease

• Published in: The Journal of heart and lung transplantation Vol. 21; no. 3; pp. 334 - 339
• Main Authors: Kaza, Aditya K, Dietz, Jeffrey F, Kern, John A, Jones, David R, Robbins, Mark K, Fiser, Steven M, Long, Stewart M, Bergin, James D, Kron, Irving L, Tribble, Curtis G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2002; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Child; Contraindications; Coronary Disease - complications; Coronary Disease - surgery; Coronary heart disease; Female; Heart; Humans; Lung Diseases - complications; Lung Diseases - surgery; Lung Transplantation; Male; Medical sciences; Middle Aged; Retrospective Studies; Risk Assessment; Human; Concomitant disease; Respiratory failure; Respiratory disease; Risk factor; Cardiovascular disease; Coronary heart disease
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/S1053-2498(01)00387-4

Significant coronary artery disease (CAD) has been a contraindication for listing patients for lung transplantation. We hypothesize that coronary risk stratification can help identify a sub-set of patients who need additional diagnostic tools and intervention. We performed a retrospective review of 72 consecutive patients who underwent lung transplantation at our institution from 1995 to 2000. Further, a review of patients who are currently listed for transplantation yielded 48 patients. We then identified the various risk factors for CAD, the diagnostic tools used, and pre-operative intervention. Risk factors identified included smoking history, diabetes, hypertension, hypercholesterolemia, CAD, congestive heart failure, age >50, and arrhythmias. Based on these risk factors, the patients were then classified into 2 groups: low risk (≤1 risk factors) and high risk (≥2 risk factors). We identified the patients in each group who underwent coronary angiography (CA), those with angiographic evidence of CAD, and those who received pre-operative intervention. Of the 72 patients who underwent lung transplantation, 48 were identified as at high risk for CAD. Of these, 5 patients had CAD diagnosed before surgery using CA, and 1 patient received pre-operative intervention. Of the 48 patients currently on the lung transplant list, we identified 28 patients as high risk for CAD, 12 of whom were noted to have CA, and 2 of whom received pre-operative intervention. Although CAD was once a contraindication for lung transplantation, pre-operative risk stratification allows identification of CAD with CA in a high-risk group. We believe that by using appropriate pre-operative cardiac intervention, patients with severe CAD could successfully undergo lung transplantation.