Reviews in DepthA systematic review and meta-analysis of coronary artery disease and revascularization in lung transplant patientsFialka, Nicholas M.a; Bozso, Sabin J.b; EL-Andari, Ryaana; Kang, Jimmy JH.b; Laing, Brycec; Meyer, Steven R.b; Nagendran, Jayanb; Nagendran, Jeevanb Author Information aFaculty of Medicine and Dentistry bDivision of Cardiac Surgery, Department of Surgery cDepartment of Surgery, University of Alberta, Edmonton, Alberta, Canada Received 11 January 2022 Accepted 10 April 2022 Correspondence to Jeevan Nagendran, MD, PhD, FRCSC, Minimally Invasive and Transcatheter Valve Surgery, University of Alberta, Mazankowski Alberta Heart Institute, 4-108A Li Ka Shing Health Research Centre, 8602 - 112 Street, Edmonton, AB T6G 2E1, Canada, Tel: +780 492 7605; fax: +780 492 6037; e-mail: [email protected] Coronary Artery Disease 33(8):p 661-669, December 2022. | DOI: 10.1097/MCA.0000000000001153 Buy Metrics Abstract Coronary artery disease (CAD) is common in candidates for lung transplantation (LTx) and has historically been considered a relative contraindication to transplantation. We look to review the outcomes of LTx in patients with CAD and determine the optimum revascularization strategy in LTx candidates. PubMed, Medline and Web of Science were systematically searched by three authors for articles comparing the outcomes of LTx in patients with CAD and receiving coronary revascularization. In total 1668 articles were screened and 12 were included in this review.Preexisting CAD in LTx recipients was not associated with significantly increased postoperative morbidity or mortality. The pooled estimates of mortality rate at 1, 3 and 5 years indicated significantly inferior survival in LTx recipients with a prior history of coronary artery bypass grafting (CABG) [odds ratio (OR), 1.84; 95% confidence interval (CI), 1.53–2.22; P < 0.00001; I2 = 0%; OR, 1.52; 95% CI, 1.21–1.91; P = 0.0003; I2 = 0%; OR, 1.62; 95% CI, 1.13–2.33; P = 0.008; I2 = 71%, respectively). However, contemporary literature suggests that survival rates in LTx recipients with CAD that received revascularization either by percutaneous coronary intervention (PCI), previous or concomitant CABG, are similar to patients who did not receive revascularization. Trends in postoperative morbidity favored CABG in the rates of myocardial infarction and repeat revascularization, whereas rates of stroke favored PCI. The composite results of this study support the consideration of patients with CAD or previous coronary revascularization for LTx. Prospective, randomized controlled trials with consistent patient populations and outcomes reporting are required to fully elucidate the optimum revascularization strategy in LTx candidates. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.