Abstract / Summary
Structured Abstract Objective Significant coronary artery disease (CAD) remains a relative contraindication to lung transplantation (LTx) affecting ∼10% of candidates. Contemporary percutaneous coronary intervention (PCI) has broadened eligibility, but optimal dual antiplatelet therapy (DAPT) duration remains unclear. AHA/ACC recommend ≥3 months DAPT after PCI for patients undergoing high bleeding risk surgeries to reduce major adverse cardiovascular events (MACE); however, delaying urgent LTx poses significant mortality risk. This study assesses safety of ADAPT (<3 months) in LTx candidates with pre-transplant PCI. Methods In this retrospective study (2011-2025), P2Y12 inhibitors were discontinued pre-listing/transplantation, and aspirin was continued perioperatively. 43 patients were stratified by DAPT duration (<3, 3–6, >6 months). The primary endpoint was MACE (stent thrombosis, myocardial infarction (MI), cardio/cerebrovascular events, cardiac death). Secondary endpoints—survival, bleeding, venous thromboembolism (VTE)—were evaluated across DAPT durations and via propensity-matched comparison with no-aspirin cohort. Results Abbreviated DAPT (ADAPT) exhibited no increased MACE (p>0.99), bleeding (p=0.82), and VTE (PE p>0.99, DVT p>0.76). One-year survival was 100% in <3- and 3-6-month groups, and 96% in >6-month group. Five-year survival remained comparable (p=0.15), with mortalities exclusively non-cardiovascular in etiology. DAPT ≤2 months (n=6) also maintained 100% 1-year survival. Perioperative aspirin demonstrated no excess bleeding risk (p=0.51) or protection against VTE events (PE p>0.99, DVT p>0.99). Conclusions In selected patients with concomitant CAD requiring urgent LTx, ADAPT (<3 months) with perioperative aspirin monotherapy can safely balance ischemic and bleeding risks. Aggressive ≤2-month DAPT may also be reasonable. Perioperative aspirin conferred no additional bleeding risk or protection against VTE events.