Feasibility of Pulmonary Resection for Lung Cancer in Patients With Coronary Artery Disease or Atrial Fibrillation

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• 作者：Yoshitaka Kitamura ; MD^a ; Kenji Suzuki ; MD ; PhD^a ; ^{kjsuzuki@juntendo.ac.jp} ; Satoshi Teramukai ; PhD^b ; Makoto Sonobe ; MD ; PhD^c ; Shinichi Toyooka ; MD ; PhD^d ; Yoshihisa Nakagawa ; MD ; PhD^e ; Hiroyasu Yokomise ; MD ; PhD^f ; Hiroshi Date ; MD ; PhD^c ; for The Japanese Association for Chest Surgery^&lowast ; ; J. Arikura ; M. Miyajima ; N. Tsunooka ; S. Ueda ; S. Shiono ; H. Ichimura ; Y. Ohtaki ; O. Kawashima ; N. Takahashi ; T. Iwata ; T. Murakawa ; Y. Shimada ; H. Horio ; H. Ishibashi ; R. Kawachi ; T. Omori ; M. Naito ; T. Hashimoto ; R. Waseda ; Y. Tsunezuka ; N. Tanaka ; T. Eguchi ; H. Agatsuma ; Y. Mizuno ; S. Nishikawa ; M. Isaka ; H. Haneda ; K. Narita ; K. Okuda ; Y. Kobayashi ; Y. Terada ; T. Takemoto ; R. Nakajima ; R. Kanzaki ; J. Okami ; Y. Kadota ; N. Hanaoka ; A. Hayashi ; W. Nishio ; Y. Takahashi ; H. Nakamura ; Y. Taniguchi ; A. Yamashina ; H. Yamamoto ; Y. Miyata ; M. Matsuura ; T. Tanaka ; N. Matsuura ; H. Suehisa ; S.S. Chang ; T. So ; T. Osaki ; S. Takeo ; M. Takenoyama ; T. Miyazaki ; T. Marutsuka ; K. Yoshimoto ; K. Kariatsumari ; M. Yanagi
• 关键词：AF ; atrial fibrillation ; APT ; antiplatelet therapy ; BMS ; bare metal stent ; CABG ; coronary artery bypass grafting ; CAD ; coronary artery disease ; CI ; confidence interval ; CVD ; cerebrovascular disease ; DES ; drug-eluting stent ; OR ; odds ratio ; PCI ; percutaneous coronary intervention ; ST ; stent thrombosis
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：103
• 期：2
• 页码：432-440
• 全文大小：161 K
• 卷排序：103

文摘

The aim of this study was to clarify the outcomes of lung resection for lung cancer in patients with cardiac disease, especially coronary artery disease, in a large-scale multi-institutional cohort.MethodsWe retrospectively analyzed the data on 1,254 patients who underwent major lung resection for lung cancer and had been diagnosed with coronary stenosis, atrial fibrillation, or both, in 58 institutions in Japan between January 2009 and December 2011. The primary outcome was 90-day postoperative mortality or in-hospital death.ResultsAmong the 1,254 patients, 902 (71.9%) and 452 patients (36.0%) were preoperatively diagnosed with coronary stenosis and atrial fibrillation, respectively, and 951 patients (75.8%) received antiplatelet therapy. Among the patients with coronary stents (n = 532; 42.4%), 204 (16.3%) received drug-eluting stents. The 90-mortality or in-hospital death rate was 2.6% (n = 32), including stent thrombosis (n = 1), thromboembolic events without stent thrombosis (n = 2), and bleeding events (n = 2). In the multivariate analyses, blood transfusion, history of cerebrovascular disease, amount of bleeding, and history of congestive heart failure were associated with a higher independent risk of 90-day mortality or in-hospital death (odds ratio, 9.400, 3.574, 2.827, and 2.945, respectively). Preoperative discontinuation of antiplatelet therapy was not associated with an independent risk of 90-day mortality or in-hospital death on univariate analysis.ConclusionsMajor lung resection for lung cancer in patients with coronary artery disease is feasible. Our study suggests that discontinuation of antiplatelet therapy may not increase postoperative complications in patients with coronary artery disease.