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Published on: May 14, 2013
Transplant coronary artery disease: Incidence, progression and interventional revascularization
Bonni Syeda1, Suzanne Roedler, Christoph Schukro
1Division of Cardiology, Department for Internal Medicine II, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. bonni.syeda@meduniwien.ac.at
Insights
Allograft coronary artery disease (CAD) incidence increases significantly after five years post-heart transplant. Coronary intervention offers better long-term outcomes for significant stenosis compared to conservative management.
Area of Science:
- Cardiology
- Transplant Medicine
- Vascular Biology
Background:
- Allograft coronary artery disease (CAD) is a primary cause of late graft loss after heart transplantation.
- Understanding CAD incidence and progression is crucial for improving long-term transplant outcomes.
Purpose of the Study:
- To analyze the incidence and progression of allograft CAD in heart transplant recipients.
- To evaluate the effectiveness of coronary interventions for CAD in this patient population.
Main Methods:
- Prospective analysis of angiographic data from heart transplant patients undergoing coronary angiography.
- Assessment of angiographic outcomes following coronary revascularization for de novo lesions.
Main Results:
- 30.9% of patients showed CAD (%DS>50%), with 19.5% having significant stenosis (%DS>70%).
- CAD incidence rises exponentially after 5 years, with 50% developing CAD by 10.1 years.
- Coronary intervention in 28 vessels showed a 25.9% binary restenosis rate, but offered better long-term results than conservative treatment for %DS>70% lesions (p=0.04).
Conclusions:
- Allograft CAD incidence accelerates significantly beyond 5 years post-transplant.
- Coronary interventions demonstrate comparable restenosis rates to other high-risk patients.
- Interventional treatment for significant stenosis (%DS>70%) yields superior mid-term outcomes compared to conservative management.
Background:
Allograft coronary artery disease (CAD) remains the main factor responsible for late graft loss. This analysis describes data on incidence and progression of allograft CAD at our institute, as well as our experience with coronary interventions in heart transplant recipients.
Methods:
Angiographic results of cardiac transplant patients undergoing coronary angiography were prospectively selected and analyzed. Angiographic outcome at follow-up were assessed for all coronary revascularizations in denovo lesions.
Results:
Four hundred thirty-two coronary angiographies were performed in a total of 246 patients. Seventy-six patients (30.9%) showed angiographic evidence of CAD with %DS>50%, of which 48 patients revealed significant stenosis with %DS>70% (19.5%). Within the first 5 years after the transplantation, 10.1% show angiographic signs of a CAD; at the time of 10.1 years, 50% of all heart transplant patients have developed a CAD. Once a CAD with %DS between 50% and 60% has evolved, the disease shows fast progression. Coronary intervention was performed in 28 vessels at an average time of 9.5 years after heart transplantation. Follow-up angiography was available for 27 vessels (1 death before re-angiography) within a mean follow-up period of 19.3 months. Binary restenosis was found in 7 out of 27 vessels (25.9%). Comparison of the occurrence of total occlusion in vessels with %DS>70% which were not revascularized to the occurrence of MACE after successful revascularization revealed better long term results in the group of patients with coronary intervention (p=0.04).
Conclusion:
Whereas coronary artery disease is found in rare cases within the first 5 years after heart transplantation, the incidence grows in exponential manner after this period. Mid-term follow-up after coronary intervention exhibit restenosis-rates which are similar to the ones of other high risk patients. Comparison of coronary intervention versus conservative treatment in vessels with %DS>70% show significant better mid-term outcome in the interventional group.
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