Coronary risk stratification in patients with end-stage lung disease.
BACKGROUND
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.


METHODS
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 (< or =1 risk factors) and high risk (> or =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.


RESULTS
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.


CONCLUSIONS
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.
Kaza
Aditya K
AK
Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-1359, USA.
Dietz
Jeffrey F
JF
Kern
John A
JA
Jones
David R
DR
Robbins
Mark K
MK
Fiser
Steven M
SM
Long
Stewart M
SM
Bergin
James D
JD
Kron
Irving L
IL
Tribble
Curtis G
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D000075202:Contraindications; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment