title: Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation.
abstract: BACKGROUND
  Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined.
  
  
  METHODS
  All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization.
  
  
  RESULTS
  Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411).
  
  
  CONCLUSIONS
  Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity.
authors.affiliation: 1 Division of General Surgery, Duke University Medical Center, Durham, NC. 2 Cardiothoracic Surgery, Duke University Medical Center, Durham, NC. 3 Cardiothoracic Surgery, University of Kentucky, Lexington, KY. 4 Duke Clinical Research Institute, Durham, NC. 5 Address correspondence to: Giorgio Zanotti, Duke University Medical Center, Duke South - White Zone, Box 3443, Durham, NC 27710.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanotti
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Martin
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult