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The Prognostic Significance of Coronary Artery Disease Interventions in Lung Transplant Candidates
Eran Yerushalmi1, Tal Abu1, David Hasdai2,3
1Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Routine coronary intervention before lung transplantation (LT) did not significantly reduce major adverse cardiac events (MACE) in LT candidates. Interventions may even increase MACE risk, particularly early post-procedure, suggesting careful consideration is needed.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Lung transplantation (LT) is critical for end-stage lung failure.
- Coronary artery disease (CAD) is prevalent in lung disease patients, necessitating pre-LT coronary angiography.
- CAD interventions aim to reduce post-LT cardiovascular events.
Purpose of the Study:
- To evaluate the prognostic impact of CAD interventions in lung transplant candidates.
- To assess pre- and post-LT outcomes related to coronary interventions.
Main Methods:
- Retrospective analysis of 450 LT candidates undergoing cardiac catheterization (2014-2019).
- Assessment for significant CAD and percutaneous coronary intervention.
- Primary outcome: Major Adverse Cardiac Events (MACE) on the waiting list; Secondary outcome: MACE post-LT.
Main Results:
- Higher MACE incidence in the intervention group (8.3%) vs. non-intervention (4.4%), p=0.007.
- 28.6% of MACE in the intervention group occurred within one month post-intervention.
- No significant difference in cardiovascular mortality or post-LT MACE rates between groups.
Conclusions:
- Pre-LT routine coronary intervention does not consistently prevent MACE in LT candidates.
- Intervention status did not significantly alter post-LT MACE rates.
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.
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