CORONARY-ARTERY DISEASE IN PATIENTS UNDERGOING LUNG-VOLUME REDUCTION SURGERY FOR EMPHYSEMA

Objectives: Most patients with severe pulmonary emphysema referred for lung volume reduction surgery (LVRS) have a long-standing history of cigarette smoking. Coronary artery disease (CAD) predisposes to periop erative cardiac complications. Since symptoms and signs of myocardial ischemia are often absent in patients with severe ventilatory impairme nt even during exercise, we investigated the prevalence of CAD in cand idates for LVRS by angiography. Design: We prospectively studied the p revalence of CAD by angiography and assessed the CAD risk factor profi le in 41 candidates for LVRS (26 men, 15 women; mean age, 66+/-6.8) ye ars; range, 52 to 76 years), who had no current symptoms or a history of myocardial ischemia. Results: In six patients (15%), asymptomatic b ut significant coronary lesions (>70 stenosis) were detected. In five patients, these findings altered the clinical management. Patients wit h CAD had significant higher cholesterol levels, tended to have smoked more, and had more often additional vascular risk factors. Conclusion s: We found a high prevalence of angiographically significant but clin ically silent CAD in this particular population of heavy smokers with advanced emphysema.