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Published on: May 14, 2013
Percutaneous coronary interventions with stents in cardiac transplant recipients
Feras M Bader1, Abdallah G Kfoury, Edward M Gilbert
1Department of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. ferasbader@hsc.utah.edu
Insights
Percutaneous coronary intervention (PCI) with stents is effective for cardiac transplant recipients, achieving high success rates. Drug-eluting stents showed a trend toward lower restenosis, warranting further investigation in larger studies.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Background:
- Allograft coronary vasculopathy poses a significant mortality risk in cardiac transplant recipients beyond the first year post-transplant.
- Percutaneous coronary intervention (PCI) is a crucial therapeutic option for managing coronary artery disease in this vulnerable population.
Purpose of the Study:
- To evaluate the safety and efficacy of PCI with stents in cardiac transplant recipients.
- To compare the outcomes of bare metal stents versus drug-eluting stents in this patient cohort.
Main Methods:
- Retrospective review of medical records for cardiac transplant recipients who underwent PCI with stents.
- Analysis of patient demographics, procedural details, and clinical outcomes, including success rates and restenosis.
- Comparison of outcomes between patients treated with bare metal stents and drug-eluting stents.
Main Results:
- PCI with stents was performed in 40 of 865 cardiac transplant recipients, with 78 stents deployed.
- Primary success rate for PCI was high (91%), with indications including asymptomatic vasculopathy, angina, myocardial infarction, and congestive heart failure.
- During follow-up, 15% of patients died and 5% were re-transplanted. Restenosis occurred in 31% of bare metal stents versus 15% of drug-eluting stents, a difference not statistically significant.
Conclusions:
- PCI with stents can be safely performed in cardiac transplant recipients with high primary success rates.
- Restenosis rates following PCI in transplant recipients are higher than in native coronary arteries.
- A trend towards reduced restenosis with drug-eluting stents suggests potential benefit, necessitating larger studies for confirmation.
Background:
Allograft coronary vasculopathy is a major cause of death beyond the first year after cardiac transplantation. The aim of this study was to review our experience with percutaneous coronary intervention (PCI) with stents in cardiac transplant recipients.
Methods:
We identified patients who were treated with PCI using stents. Patient characteristics, procedure information and clinical outcomes were assessed for these patients by review of their medical records. We also compared results for those who had bare metal stents vs those who had drug-eluting stents.
Results:
Forty patients from our program's 865 cardiac transplant recipients received a total of 78 coronary stents. There were 35 males (87.5%) and 5 females (12.5%). The indication for PCI was progressive asymptomatic coronary vasculopathy in 18 patients (45%), angina in 5 (12.5%), acute myocardial infarction (MI) in 4 (10%) and congestive heart failure (CHF) in 6 (15%). Primary success (<50% residual stenosis) was obtained in 71 (91%) of 78 stents. During the mean follow-up of 40.8 +/- 34.5 months, 6 patients died (15%) and 2 (5%) were re-transplanted. There was a lower rate of re-stenosis with drug-eluting stents (2 of 13, 15%) compared with bare metal stents (20 of 65, 31%), although this difference was not statistically significant (p = 0.27).
Conclusions:
In cardiac transplant recipients, PCI with stents can be performed with high rates of primary success. Restenosis rates are higher compared with PCI in native coronary arteries. A trend toward less restenosis with drug-eluting stents was observed, which needs to be confirmed in larger studies.
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