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Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy.

Publication ,  Journal Article
Pandey, AK; Lee, NS; Marsal, J; Knowlton, KU; McDivit, AM; Blanchard, DG; Pretorius, V; Madani, MM; Fedullo, PF; Kerr, KM; Kim, NH; Poch, DS ...
Published in: Ann Thorac Surg
May 2021

BACKGROUND: At the University of California, San Diego, routine coronary angiography has generally been performed in men 40 years of age and older and women 45 years of age and older before pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH). The prevalence of significant coronary artery disease (CAD) in this population has not been evaluated, however, and the optimal screening strategy has not been established. This study sought to evaluate whether the current approach may be better optimized on the basis of cardiac risk factors. METHODS: This study included 462 consecutive patients with CTEPH who were undergoing preoperative coronary angiography for pulmonary thromboendarterectomy. Baseline demographic and medical information was recorded. Major cardiac risk factors included: diabetes, hypertension, hyperlipidemia, body mass index 25 kg/m2 or greater, tobacco use, and family history of CAD. Charts were then reviewed for presence of significant CAD and revascularization. RESULTS: Significant CAD was found in 13.4% of patients who underwent routine preoperative coronary angiography; it was present in only 5% of patients younger than 50 years of age, compared with 16% of patients 50 years old and older. No patient younger than 50 years of age without cardiac risk factors was found to have significant CAD. Furthermore, in patients younger than 50 years of age, significant CAD was found only among those with 3 or more major risk factors. CONCLUSIONS: In patients younger than 50 years of age with CTEPH, the prevalence of significant CAD was low. Omitting preoperative coronary angiography in this subset of patients is reasonable when no coronary risk factors are present. Preoperative coronary angiography is warranted in individuals 50 years of age and older, as well as in those younger than 50 years who have significant risk factors for CAD.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

May 2021

Volume

111

Issue

5

Start / End Page

1703 / 1709

Location

Netherlands

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Pulmonary Embolism
  • Prevalence
  • Preoperative Period
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Pandey, A. K., Lee, N. S., Marsal, J., Knowlton, K. U., McDivit, A. M., Blanchard, D. G., … Daniels, L. B. (2021). Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy. Ann Thorac Surg, 111(5), 1703–1709. https://doi.org/10.1016/j.athoracsur.2020.06.107
Pandey, Amit K., Noel S. Lee, Jamie Marsal, Kirk U. Knowlton, Anna M. McDivit, Daniel G. Blanchard, Victor Pretorius, et al. “Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy.Ann Thorac Surg 111, no. 5 (May 2021): 1703–9. https://doi.org/10.1016/j.athoracsur.2020.06.107.
Pandey AK, Lee NS, Marsal J, Knowlton KU, McDivit AM, Blanchard DG, et al. Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy. Ann Thorac Surg. 2021 May;111(5):1703–9.
Pandey, Amit K., et al. “Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy.Ann Thorac Surg, vol. 111, no. 5, May 2021, pp. 1703–09. Pubmed, doi:10.1016/j.athoracsur.2020.06.107.
Pandey AK, Lee NS, Marsal J, Knowlton KU, McDivit AM, Blanchard DG, Pretorius V, Madani MM, Fedullo PF, Kerr KM, Kim NH, Fernandes TM, Poch DS, Auger WR, Daniels LB. Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy. Ann Thorac Surg. 2021 May;111(5):1703–1709.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

May 2021

Volume

111

Issue

5

Start / End Page

1703 / 1709

Location

Netherlands

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Pulmonary Embolism
  • Prevalence
  • Preoperative Period
  • Middle Aged
  • Male
  • Humans
  • Female