The Prognostic Significance of Coronary Artery Disease Interventions in Lung Transplant Candidates.

Abstract

Introduction: Lung transplantation (LT) is a lifesaving procedure in patients with end stage lung failure. The prevalence of coronary artery disease (CAD) in patients with lung disease is comparably high, and coronary angiography is widely used for coronary anatomy assessment prior to LT. Detection of significant CAD usually results in revascularization to minimize posttransplant cardiovascular events. We aim to examine the prognostic significance of CAD interventions on LT candidates pre- and post-LT.

Methods: From a retrospective registry of 450 LT candidates undergoing cardiac catheterization during 2014-2019, patients were assessed for the presence of significant CAD and percutaneous coronary intervention. The primary outcome was defined as occurrence of major advance cardiac events (MACE) in LT candidates while on the waiting list. MACE comprising of cardiovascular mortality, nonfatal myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery. Secondary outcomes were the occurrence of MACE posttransplant according to the coronary intervention status.

Results: MACE was recorded in 22 LT candidates, with a higher incidence in the intervention group compared to the nonintervention group (8.3% vs. 4.4%, p = 0.007). 28.6% of MACE events in the intervention group occurred in the first month after intervention. Cardiovascular mortality accounted for 8.6% of all deaths, without significant difference between the intervention and nonintervention group (16.0% vs. 7.2%, p = 0.155). The rates of MACE post-LT were mildly and nonsignificantly increased in the intervention group compared to the nonintervention group (11.1% vs. 4.5%, p = 0.18).

Conclusion: Pre-LT routine coronary intervention does not necessarily protect patients from experiencing MACE while on the waiting list or post-LT.