Key result
Prior myocardial revascularization linked to ~31% shorter hospital stay after lung resection.
Why the study?
Feasibility of lung resection in patients with lung cancer and concomitant coronary arterial disease depends on cardiac impairment severity, which may increase operative morbidity and mortality.
Does prior myocardial revascularization improve short-term outcomes in patients with coronary arterial disease undergoing lung resection for cancer?
Cohort (n=50)
No
Does prior myocardial revascularization improve short-term outcomes in patients with coronary arterial disease undergoing lung resection for cancer?
Absolute Event Rate: 8.1% vs 11.7%
In patients with coronary artery disease undergoing lung cancer resection, prior myocardial revascularization and limited resections may decrease operative complications and hospital stay.
May support preoperative revascularization before lung resection in selected CAD patients; leaves open need for prospective validation of selection criteria.
OBJECTIVE: Patients with lung cancer may present concomitant coronary arterial disease. Feasibility of lung resection is dependent on the severity of the cardiac impairment since it can increase operative morbidity and mortality. The aim of this study was to analyze the results of lung resection in patients with coronary arterial disease in terms of operative complications and hospital stay. METHODS: Between January 1993 and March 2001, 50 patients with coronary arterial disease underwent lung resection for cancer at our department. Nineteen patients with a curable left-main or multiple-vessel disease first underwent surgical (six patients) or transluminal (13 patients) myocardial revascularization. Twenty-two of the 31 patients who did not require myocardial revascularization presented a medium-high cardiac risk. Univariate analysis determined the impact of coronary disease on operative complications and hospital stay. RESULTS: Surgery consisted in 40 lobectomies, three pneumonectomies and seven wedge resections. The overall mortality and morbidity rates were 4% and 28%, respectively. Ten patients (22%) experienced postoperative cardiac complications such as arrhythmia and there was one intraoperative death, three suffered secretion retention and one patient died as a consequence of a stroke. Occurrence of postoperative complications was influenced by age (P=0.02) and the presence of medium-high cardiac risk (P=0.03). Hospital stay was longer for patients who did not have prior myocardial revascularization (11.7+/-4 vs. 8.1+/-3 days) and underwent more extensive pulmonary resection (10.6+/-5 vs. 7.4+/-2 days). CONCLUSIONS: Lung resection in patients with coronary arterial disease is justified in selected cases. Previous myocardial revascularization and limited resections can decrease operative complications and hospital stay. Careful preoperative evaluation can identify patients who might benefit from myocardial revascularization prior to surgery.
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Ciriaco et al. (2002) conducted a cohort in Lung cancer with concomitant coronary arterial disease (n=50). Prior myocardial revascularization vs. No prior myocardial revascularization was evaluated on Hospital stay (days). Prior myocardial revascularization before lung resection in patients with coronary arterial disease was associated with a shorter hospital stay (8.1 vs 11.7 days).
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