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Selected lung transplant candidates with significant coronary artery disease can undergo transplantation with equal mortality risk to those without CAD


A study has examined the correlation between pre-operative coronary artery disease ( CAD ) and post-operative cardiovascular events in lung transplant recipients.

Consecutive isolated lung transplant recipients from 2007 to 2013 at Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas ( U.S. ) were identified and categorized as having significant coronary artery disease ( greater than or equal to 50% coronary stenosis in at least 1 artery or history of coronary revascularization ) or no-mild coronary artery disease.

Patient records and death index data were analyzed for a median of 2 years for death or cardiovascular events, including coronary, cerebrovascular, and peripheral artery events.

The study comprised 280 patients ( 62% male ) with mean age of 60 ± 10 years.

Cardiovascular events occurred in 5.7% ( 16 of 280 ) of the entire cohort. Patients with significant coronary artery disease had a higher annualized rate of cardiovascular events than those with no-mild coronary artery disease ( 11.9% vs 0.6%; p less than 0.001 ).

Significant coronary artery disease was an independent predictor of cardiovascular events ( hazard ratio, HR=20.32; 95% confidence interval, 5.79-71.26; p less than 0.001 ) but not all-cause mortality ( log-rank p = 0.66 ).

Adding significant coronary artery disease to clinical risk factors gave incremental prognostic performance compared with clinical risk factors alone ( p less than 0.001 for increase in global chi-square ).

In conclusion, selected lung transplant candidates with significant coronary artery disease can undergo transplantation with equal mortality risk to those without coronary artery disease but are at a higher risk of non-fatal cardiovascular events.
These data support the current practice of accepting a selected group of patients with coronary artery disease for lung transplantation and suggest that they should be monitored early and treated to prevent cardiovascular complications. ( Xagena )

Chaikriangkrai K et al, J Heart Lung Transplant 2015; Epub ahead of print

XagenaMedicine_2015



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