Prevalence of obstructive coronary artery disease in patients undergoing lung transplantation: Case series and review of the literature

Abstract

Background Coronary angiography is commonly performed prior to lung transplantation, but its utility is unproven. Methods We conducted a single-center retrospective analysis of consecutive patients referred for coronary angiography as part of a pre-operative evaluation for lung transplantation and reviewed the literature for prior series. Results A total of 89 patients, 48 men and 41 women were included. Obstructive (≥ 70% stenosis) CAD was present in 9 (10%), non-obstructive (< 70% stenosis) CAD in 24 (27%), and no angiographic evidence of CAD in 56 (63%) patients. We found 13 previously published series in the literature, in which a total of 1998 patients underwent coronary angiography pre-lung transplant. Together with our 89 patients, obstructive CAD was found in 11%. Conclusions In conclusion, given the low prevalence of obstructive CAD in patients referred for lung transplantation, the inherent risk of angiography and unproven benefit of detection of obstructive CAD, the utility of routine coronary angiography in this population requires validation in prospective studies.

Lung transplant patients with coronary artery disease rarely die of cardiac causes

“…As there is a high incidence of CAD in the lung transplant population, the arguments for and against routine preoperative CA have been debated by other investigators . Stenting lesions in asymptomatic lesions are in general discouraged by the American College of Cardiology Foundation in its appropriate use criteria document .…”

“…For coronary artery disease, end‐organ ischemia has immediate consequences that can progress to infarction, heart failure, or arrhythmia. For this reason, LT patients at risk of coronary artery disease (CAD) routinely undergo preoperative coronary angiography (CA) . Depending on the definition used, CAD is present in 10%‐60% of patients with advanced lung disease .…”

“…For this reason, LT patients at risk of coronary artery disease (CAD) routinely undergo preoperative coronary angiography (CA) . Depending on the definition used, CAD is present in 10%‐60% of patients with advanced lung disease . The preoperative evaluation, degree of CAD deemed acceptable, and preferred method of revascularization differ among transplant centers .…”

Coronary artery disease in lung transplant patients

“…They determined a prevalence of obstructive CAD of 10% in lung transplant patients at their center. 15 They also searched for published research and included 13 articles that matched their criteria. Of those 13 studies, only five defined CAD the same as they did.…”

“…When analyzing the results from the six studies, the conclusion was that prevalence of obstructive CAD in lung transplant patients was 11%. [15][16][17][18][19][20] reported that in patients with >4 risk factors CAD was always significant. However, they stated that patients with <3 risk factors still had 11% risk of significant CAD.…”