Coronary Artery Disease Screening For Lung Transplant Candidates

Purpose Lung transplant (LTx) candidates have increase age and higher incidence of Coronary Artery Disease (CAD). As CAD is often asymptomatic, its identification is not always straightforward, therefore, LTx candidates need to be submitted to a meticulous screening before entering the waitlist. Although coronary angiography (CA) is the gold standard test for this purpose, it\u0027s an invasive exam with possible complications. We revised all CA in the LTx candidates in the last 5 years regarding diagnoses, treatments and outcomes. Methods We conducted a retrospective study reviewing medical records between January/2014 - December/2019 of all LTx candidates in a single LTx center in Sao Paulo, Brazil. All candidates of 40 years-old and older undergo a CA independently of risk factor or comorbidities. Therefore, we revised all CA performed to analyze the findings, complications and outcomes in all patients submitted to this exam. Results A total of 526 LTx candidates medical records were analyzed. Coronary angiography was performed in 234 patients (44%). Of all procedures, 30 (12,8%) patients had at least 1 coronary artery injury; 28 (93,3%) of them were over 50 years old. Out of these 28 patients, 18 had LTx contraindicated, 5 were submitted to LTx, 4 died during the waiting list, 1 is still at waitlist and 2 are in evaluation pre-LTx.From all 234 CA, there were 5 (2,1%) unexpected complications: 2 right coronary vasospasms, 1 stroke, 1 descending anterior coronary artery dissection and 1 radial artery lesion. Among these complications, 3 patients had less than 50 years old.No patients were submitted to myocardial revascularization before or during the transplant and 9 (30%) patients underwent angioplasty: 8 patients had LTx contraindication because of multiple comorbidities and 1 patient is still on the waiting list. Conclusion Our study reinforces the screening for CAD among LTx candidates, especially in those over 50 years-old. Maybe, for patients between 40 - 50 years-old, CA should only be considered if risk factors are present.