Impact of previous percutaneous coronary intervention on cardiovascular outcomes and mortality after lung cancer surgery: A nationwide study in Korea

Abstract

Background The number of patients with operable lung cancer with a history of percutaneous coronary intervention (PCI) has increased. However, cardiovascular outcomes and mortality, according to the time from PCI to surgery, and the follow‐up time after surgery are largely unknown. Here, we aimed to compare the cardiovascular outcomes and mortality of these patients with a history of PCI to those of patients without a history of PCI. Methods Using the Korean National Health Insurance Service Database, we selected 30 750 patients who underwent surgery for lung cancer between 2006 and 2014. Study outcome variables were all‐cause mortality, revascularization, intensive care unit (ICU) readmission, and stroke incidence. Patients were followed‐up until 2016. Results Of the 30 750 patients, 513 (1.7%) underwent PCI before surgery. The PCI group did not show an increased risk of death, ICU readmission, or stroke within one year of surgery, despite an increased risk of revascularization. However, one year after surgery, they showed a higher risk of death and revascularization than the non‐PCI group. The risk of revascularization was highest when the interval between PCI and surgery was <1 year and remained high when the interval was >3 years. Conclusions Patients who underwent PCI before surgery for lung cancer were at a higher risk of death than those in the non‐PCI group at one year after surgery. In addition, they showed higher short‐ and long‐term risks of revascularization than patients in the non‐PCI group. Careful long‐term management of cardiovascular risk is necessary for this population.

Safety of Perioperative Maintenance of Antiplatelet Agents in Elderly Patients Undergoing Lung Cancer Surgery

“…However, guidelines recommend http://www.jchestsurg.org JCS maintaining antiplatelet therapy because thrombotic complications are more serious and can result in long-term sequelae or death. A Korean nationwide study showed that interrupting antiplatelet therapy during pulmonary resection increases the risk of major adverse cardiac events (MACE) [16]. Additionally, interruption of antiplatelet therapy within the first month after percutaneous coronary intervention (PCI) is known to be significantly associated with an increased MACE rate [17].…”

A Review of Advances in the Surgical Treatment of Coronary Heart Disease and Lung Cancer

“…Additionally, these patients should not have a recent history of myocardial cancer infiltration but should have a history of myocardial infarction, PCI failure, or infeasible unstable angina. For patients, particularly those unable to undergo a second operation, the combined procedure is deemed secure, yielding positive outcomes and a favorable prognosis [14,42,[64][65][66].…”

“…However, there exists a significant controversy regarding the extent of lymph node dissection. While thorough systematic lymph node dissection is generally deemed beneficial, some studies question the survival advantage compared to more limited dissection [14]. Furthermore, systematic lymph node dissection prolongs operation time and increases the postoperative incidence rate [96].…”

“…The surgical management of coronary heart disease in patients with lung cancer primarily involves three approaches: (1) staged PCI followed by lung cancer resec-tion; (2) two-stage CABG followed by lung cancer resec-tion; (3) simultaneous CABG and lung cancer resection, which encompasses both on-pump CABG and off-pump CABG. Previous studies have indicated a higher postoperative mortality risk for patients who undergo PCI prior to lung cancer surgery compared to those in the non-PCI group [14]. Performing surgery in two stages can result in two wounds and increase pain and pressure on patients.…”

Comparison of preservation, dissection of 50% and 100% inferior pulmonary ligament during video-assisted thoracoscopic surgery in upper lobectomy of lung cancer

“…Video-assisted thoracoscopic surgery (VATS) was preferred for patients with early-stage lung cancer because this minimally invasive surgery can increase long-term survival and reduce complications [1][2][3][4] .…”