Abstract 14772: Routine Coronary Angiography Prior to Pulmonary Thromboendarterectomy in Patients With Chronic Thromboembolic Pulmonary Hypertension

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Introduction: At UC San Diego Health System, routine coronary angiography has been performed in men >40 years and women >45 years (or earlier in those with significant cardiovascular risk factors) prior to pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). However, the prevalence of significant coronary artery disease (CAD) in this population has not been evaluated, and the optimal screening strategy has not been systematically established. Hypothesis: We hypothesized that the current approach of routine age-based coronary angiography in screening candidates for PTE may be better optimized based on cardiac risk factors. Methods: The study included 349 consecutive patients (51.3% male) with CTEPH undergoing preoperative coronary angiography for PTE between January 1, 2007 and November 7, 2014. Charts were reviewed for baseline demographic and medical information. Major cardiac risk factors included: diabetes, hypertension, hyperlipidemia, obesity (BMI ≥25 kg/m2), tobacco use, and family history of CAD. Coronary angiography reports and PTE operative reports were reviewed for significant CAD (≥50% obstruction) and revascularization. Results: Significant CAD was found in 43 (12.3%) of the 349 patients who underwent routine preoperative coronary angiography. The subset with significant CAD included 14 (8.2%) of 170 women and 29 (16.2%) of 179 men. Significant CAD was present in only 5.6% of patients ≤50 years of age, compared to 14.6% of patients >50 years of age. The absence of major cardiac risk factors was a key indicator in excluding significant CAD in patients ≤50 years: no patient ≤50 years without risk factors for CAD was found to have significant coronary artery obstruction. Furthermore, in patients ≤50 years, significant CAD was found only among those with ≥3 major risk factors. Conclusions: In patients ≤50 years with CTEPH, the prevalence of significant CAD was low, and omitting preoperative coronary angiography in this subset of men and women may be reasonable when no cardiac risk factors are present. Routine preoperative coronary angiography is reasonable in individuals >50 years, as well as those ≤50 years with significant risk factors or clinical suspicion of CAD.