Study objectives: To review the experience of the
Alfred Hospital in the systematic assessment of coronary artery disease
(CAD) using coronary angiography (CA), and the subsequent management of
CAD, in potential lung transplant recipients.
Design: Retrospective study.
Alfred Hospital Lung and Heart Transplant Service.
Patients: CAD risk factors were sought in potential
recipients of lung transplantation (LTx) who were > 50 years old,
including a history of smoking, male gender, hypertension, diabetes,
hypercholesterolemia, angina, and a family history of CAD. When
feasible, and in the presence of more than one cardiac risk factor, CA
Results: From 243 referral
patients who were > 50 years old, 97 were listed for LTx, and 77
underwent LTx. Four patients were refused LTx on the basis of CAD. Of
101 patients undergoing a detailed cardiac assessment for LTx, 83 had
smoked, 56 were male, 48 had hypercholesterolemia, 22 had hypertension,
4 had diabetes, and 3 had a history consistent with angina.
Eighty-five patients underwent CA. In 32 cases, CA revealed CAD, and
half of these cases were significant stenoses. Eight patients who were
assessed required intervention. Five patients of this group have been
transplanted; of these, three patients underwent coronary artery
grafting at the time of LTx, and two patients underwent preoperative
angioplasty or stenting. Only one of these five patients died < 90
CAD is a common finding in older patients who are presenting for LTx.
Coronary revascularization for severe large vessel stenoses can allow
safe LTx. CAD risk factors may predict who should undergo CA, but
further studies of clinical and noninvasive assessments of CAD are
needed if CA is to be safely avoided in patients at low risk of