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(Chest. 2005;128:2557-2562.)
© 2005 American College of Chest Physicians

Is Routine Coronary Angiography and Revascularization Indicated Among Patients Undergoing Evaluation for Lung Transplantation?*

Itsik Ben-Dor, MD; David Shitrit, MD; Mordechai R. Kramer, MD, FCCP; Zaza Iakobishvili, MD, PhD; Gideon Sahar, MD and David Hasdai, MD

* From the Departments of Cardiology (Drs. Ben-Dor, Iakobishvili, and Hasdai), Pulmonology (Drs. Shitrit and Kramer), and Cardiothoracic Surgery (Dr. Sahar), Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel.

Correspondence to: David Hasdai, MD, Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, Israel 49100; e mail: dhasdai{at}post.tau.ac.il

Objectives: To review coronary artery disease (CAD) prevalence among lung transplantation (LTx) candidates, the time interval from coronary angiography (CA) to LTx/death, and postrevascularization 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 ≥ 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 21patients (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.

Key Words: coronary angiography • coronary artery disease • lung • transplantation • revascularization






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