Feasibility of Pulmonary Resection for Lung Cancer in Patients With Coronary Artery Disease or Atrial Fibrillation

• Published in: The Annals of thoracic surgery Vol. 103; no. 2; pp. 432 - 440
• Main Authors: Kitamura, Yoshitaka, MD, Suzuki, Kenji, MD, PhD, Teramukai, Satoshi, PhD, Sonobe, Makoto, MD, PhD, Toyooka, Shinichi, MD, PhD, Nakagawa, Yoshihisa, MD, PhD, Yokomise, Hiroyasu, MD, PhD, Date, Hiroshi, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2017
• Subjects: Age Distribution; Aged; Aged, 80 and over; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Cardiothoracic Surgery; Cause of Death; Comorbidity; Confidence Intervals; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Databases, Factual; Feasibility Studies; Female; Hospital Mortality; Humans; Japan; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pneumonectomy - methods; Pneumonectomy - mortality; Preoperative Care - methods; Prognosis; Retrospective Studies; Risk Assessment; Sex Distribution; Surgery; Survival Analysis; Treatment Outcome; coronary artery disease; ST; cerebrovascular disease; drug-eluting stent; OR; AF; APT; CI; CAD; BMS; antiplatelet therapy; odds ratio; CVD; atrial fibrillation; percutaneous coronary intervention; DES; stent thrombosis; PCI; bare metal stent; confidence interval; CABG; coronary artery bypass grafting
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.08.077

Background The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort. Methods We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death. Results Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis. Conclusions Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.