Is routine coronary angiography and revascularization indicated among patients undergoing evaluation for lung transplantation?
OBJECTIVE
To review coronary artery disease (CAD) prevalence among lung transplantation (LTx) candidates, the time interval from coronary angiography (CA) to LTx/death, and post-revascularization outcomes.


BACKGROUND
CA is advised for LTx candidates because significant CAD is a contraindication for LTx.


METHODS
We monitored all LTx candidates from 1997 who underwent CA. Significant CAD was defined as stenosis > or = 70% in diameter.


RESULTS
Of 118 candidates > 40 years old (68.3% men; median age, 58 years; 25 to 75th interquartiles, 53 to 61 years), 59 patients underwent LTx, 56 patients were eligible for LTx, and 3 patients were excluded due to CAD. Significant CAD was detected in 21 patients (17.8%), nonsignificant CAD was found in 21 patients (17.8%), and no CAD was found in 76 patients (64.4%), without significant differences in the demographic/clinical profile among patients with or without significant CAD. Among 21 patients with significant CAD, 12 patients (57.1%) underwent successful percutaneous coronary intervention (PCI), 1 patient had failed to respond to PCI, and 8 patients (38.1%) had no intervention. After PCI, one patient had periprocedural infarction, one patient had stent thrombosis, and one patient had symptomatic restenosis. The median time interval CA to LTx/death/last visit among the 115 candidates was 166 days (interquartiles, 48 to 410 days). Death occurred before LTx in 30 patients (53.5%) during a follow-up of 312 days (interquartiles, 46 to 664 days) and after LTx in 14 patients (23.7%) during a follow-up of 142 days (interquartiles, 73 to 304 days), without any difference in outcome based on severity of CAD in the two groups (p = 0.7 and p = 0.6, respectively).


CONCLUSIONS
CAD prevalence among LTx candidates is low and cannot be accurately predicted by risk factors. Revascularization may be associated with complications, and the time interval between revascularization and LTx may be long. Conversely, certain patients with significant CAD underwent LTx without complications. The practice of routine CA and revascularization prior to LTx should be reconsidered, and perhaps reserved for selected patients with high-risk features.
Ben-Dor
Itsik
I
Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, Israel 49100.
Shitrit
David
D
Kramer
Mordechai R
MR
Iakobishvili
Zaza
Z
Sahar
Gideon
G
Hasdai
David
D
D015331:Cohort Studies; D000075202:Contraindications; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010101:Oxygen Consumption; D018579:Patient Selection; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left