Impact of pre-operative coronary artery disease on cardiovascular events following lung transplantation

BACKGROUND: This study examined the correlation between pre-operative coronary artery disease (CAD) and post-operative cardiovascular events in lung transplant recipients. METHODS: Consecutive isolated lung transplant recipients from 2007 to 2013 in our institution were identified and categorized as having significant CAD ( >= 50% coronary stenosis in at least 1 artery or history of coronary revascularization) or no mild CAD. 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. RESULTS: 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 CAD had a higher annualized rate of cardiovascular events than those with no mild CAD (11.9% vs 0.6%; p < 0.001). Significant CAD was an independent predictor of cardiovascular events (hazard ratio, 20.32; 95% confidence interval, 5.79-71.26; p < 0.001) but not all-cause mortality (log-rank p = 0.66). Adding significant CAD to clinical risk factors gave incremental prognostic performance compared with clinical risk factors alone (p < 0.001 for increase in global chi-square). CONCLUSION: Selected lung transplant candidates with significant CAD can undergo transplantation with equal mortality risk to those without CAD bit are at a higher risk of non-fatal cardiovascular events. These data support the current practice of accepting a selected group of patients with CAD for lung transplantation and suggest that they should be monitored early and treated to prevent cardiovascular complications. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.