Impact of pre-operative coronary artery disease on cardiovascular events following lung transplantation

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 1; pp. 115 - 121
• Main Authors: Chaikriangkrai, Kongkiat, Jyothula, Soma, Jhun, Hye Yeon, Estep, Jerry, Loebe, Matthias, Scheinin, Scott, Torre-Amione, Guillermo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Aged; Cardiovascular Diseases - epidemiology; cardiovascular events; Coronary Angiography; coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; correlation; Female; Humans; Incidence; Lung Diseases - complications; Lung Diseases - surgery; lung transplantation; Lung Transplantation - adverse effects; Male; Middle Aged; mortality; preoperative; Preoperative Period; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; stroke; Surgery; survival; Survival Rate - trends; Texas - epidemiology; coronary artery disease; cardiovascular events; preoperative; correlation; survival; mortality; lung transplantation; prognosis; stroke
• ISSN: 1053-2498; 1557-3117; 1557-3117
• DOI: 10.1016/j.healun.2015.08.009

This study examined the correlation between pre-operative coronary artery disease (CAD) and post-operative cardiovascular events in lung transplant recipients. Consecutive isolated lung transplant recipients from 2007 to 2013 in our institution were identified and categorized as having significant CAD (≥ 50% coronary stenosis in at least 1 artery or history of coronary revascularization) or no–mild CAD. Patient records and death index data were analyzed for a median of 2 years for death or cardiovascular events, including coronary, cerebrovascular, and peripheral artery events. The study comprised 280 patients (62% male) with mean age of 60 ± 10 years. Cardiovascular events occurred in 5.7% (16 of 280) of the entire cohort. Patients with significant CAD had a higher annualized rate of cardiovascular events than those with no–mild CAD (11.9% vs 0.6%; p < 0.001). Significant CAD was an independent predictor of cardiovascular events (hazard ratio, 20.32; 95% confidence interval, 5.79–71.26; p < 0.001) but not all-cause mortality (log-rank p = 0.66). Adding significant CAD to clinical risk factors gave incremental prognostic performance compared with clinical risk factors alone (p < 0.001 for increase in global chi-square). Selected lung transplant candidates with significant CAD can undergo transplantation with equal mortality risk to those without CAD but are at a higher risk of non-fatal cardiovascular events. These data support the current practice of accepting a selected group of patients with CAD for lung transplantation and suggest that they should be monitored early and treated to prevent cardiovascular complications.