title: Coronary artery disease in lung transplant candidates: role of routine invasive assessment.
abstract: BACKGROUND
  An atherosclerotic disease burden sufficient to put lung transplant candidates at risk for end-organ disease after transplantation is considered to be a relative contraindication for lung transplantation.
  
  
  OBJECTIVE
  The aim of this study was to assess our current practice of cardiac workup by coronary angiography in lung transplant candidates ≥50 years of age.
  
  
  METHODS
  We retrospectively analyzed 50 consecutive lung transplant candidates ≥50 years of age in which coronary angiography was performed at the University Hospital Zurich (2009-2013). For every patient, the risk of developing an acute coronary event was estimated by using a recalibrated version of the PROCAM study calculator for the Swiss population.
  
  
  RESULTS
  The median estimated risk of developing an acute coronary event within 10 years in the study cohort (n = 50) was 4.2% (interquartile range 1.9-7.6), which is considered to be a low risk. Sixteen percent of patients were considered to be at intermediate risk. In 66% of patients, coronary angiography showed no coronary artery disease (CAD). In 28% of patients, CAD without significant stenosis was diagnosed. In 6% of patients, significant coronary stenosis was detected requiring percutaneous coronary intervention. No correlation between the coronary status and the risk score or cardiovascular risk profile was found.
  
  
  CONCLUSIONS
  The high prevalence of asymptomatic CAD in lung transplant candidates without correlation to a common clinical risk score supports the important role of coronary angiography for the assessment of coronary artery status. This approach might prevent cardiovascular events and improve long-term survival after transplantation.
authors.affiliation: Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wild
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.forename: Bruno Dieter
authors.initials: BD
authors.lastname: Isenring
authors.forename: Urs
authors.initials: U
authors.lastname: Buergi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kurowski
authors.forename: Macé M
authors.initials: MM
authors.lastname: Schuurmans
authors.forename: Lars C
authors.initials: LC
authors.lastname: Huber
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology