Coronary artery disease in patients undergoing lung volume reduction surgery for emphysema.
OBJECTIVE
Most patients with severe pulmonary emphysema referred for lung volume reduction surgery (LVRS) have a long-standing history of cigarette smoking. Coronary artery disease (CAD) predisposes to perioperative cardiac complications. Since symptoms and signs of myocardial ischemia are often absent in patients with severe ventilatory impairment even during exercise, we investigated the prevalence of CAD in candidates for LVRS by angiography.


METHODS
We prospectively studied the prevalence of CAD by angiography and assessed the CAD risk factor profile in 41 candidates for LVRS (26 men, 15 women; mean age, 66+/-6.8 years; range, 52 to 76 years), who had no current symptoms or a history of myocardial ischemia.


RESULTS
In six patients (15%), asymptomatic but significant coronary lesions (> 70% stenosis) were detected. In five patients, these findings altered the clinical management. Patients with CAD had significant higher cholesterol levels, tended to have smoked more, and had more often additional vascular risk factors.


CONCLUSIONS
We found a high prevalence of angiographically significant but clinically silent CAD in this particular population of heavy smokers with advanced emphysema.
Thurnheer
R
R
Department of Internal Medicine, University Hospital of Zurich, Switzerland.
Muntwyler
J
J
Stammberger
U
U
Bloch
K E
KE
Zollinger
A
A
Weder
W
W
Russi
E W
EW
D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000453:epidemiology / Q000601:surgery*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*