title: Feasibility of Pulmonary Resection for Lung Cancer in Patients With Coronary Artery Disease or Atrial Fibrillation.
abstract: BACKGROUND
  The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort.
  
  
  METHODS
  We retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death.
  
  
  RESULTS
  Among the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis.
  
  
  CONCLUSIONS
  Major lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.
authors: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors: Yoshitaka
authors: Y
authors: Kitamura
authors: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: kjsuzuki@juntendo.ac.jp.
authors: Kenji
authors: K
authors: Suzuki
authors: Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Satoshi
authors: S
authors: Teramukai
authors: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors: Makoto
authors: M
authors: Sonobe
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
authors: Shinichi
authors: S
authors: Toyooka
authors: Division of Cardiology, Tenri Hospital, Nara, Japan.
authors: Yoshihisa
authors: Y
authors: Nakagawa
authors: Department of General Thoracic, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors: Hiroyasu
authors: H
authors: Yokomise
authors: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors: Hiroshi
authors: H
authors: Date
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome