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Usefulness and safety of percutaneous coronary interventions for cardiac transplant vasculopathy
Koji Tanaka1, Haiyan Li, Peter J Curran
1University of California, Los Angeles, Center for Health Sciences, Los Angeles, California, USA.
Insights
Percutaneous coronary intervention (PCI) for transplant coronary artery disease (CAD) shows acceptable outcomes in heart transplant recipients. Drug-eluting stents reduced restenosis, improving survival rates in this high-risk group.
Area of Science:
- Cardiology
- Transplant Surgery
- Interventional Cardiology
Background:
- Progressive coronary vascular obliteration is a significant cause of late morbidity and mortality post-orthotopic heart transplantation.
- Transplant coronary artery disease (CAD) management remains a challenge, with limited data on the long-term efficacy of percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the longitudinal results and restenosis rates of PCI in patients with transplant CAD.
- To identify factors influencing restenosis and survival after PCI in heart transplant recipients.
Main Methods:
- Retrospective analysis of 65 heart transplant patients who underwent PCI for transplant CAD between 1993 and 2004.
- Assessment of procedural success, angiographic follow-up, restenosis rates, and survival data.
- Multivariate analysis of clinical, angiographic, and immunologic variables.
Main Results:
- PCI procedural success rate was 93%.
- The global restenosis rate was 36% at 9.5 months post-PCI.
- Drug-eluting stents showed a lower restenosis rate (19%) compared to bare metal stents (31%).
- The 5-year actuarial survival rate was 56% after the first PCI.
Conclusions:
- PCI offers acceptable immediate and long-term results for transplant CAD, despite higher restenosis rates than in non-transplant patients.
- Drug-eluting stents appear effective in reducing restenosis in the inflammatory environment of transplant CAD.
- PCI may improve actuarial survival in orthotopic heart transplant recipients compared to historical controls.
Abstract:
Late morbidity and death as a result of progressive coronary vascular obliteration remains a major unsolved problem after orthotopic heart transplantation. Various percutaneous catheter intervention (PCI) methods have been used to treat transplant coronary artery disease (CAD), but few reports have assessed the longitudinal results of these procedures. Of 1,440 cardiac transplant patients at University of California, Los Angeles, Medical Center, treated between 1984 and 2004, 65 patients who had undergone orthotopic heart transplantation underwent PCI on a total of 156 coronary artery lesions because of transplant CAD between July 1993 and August 2004. The procedural success rate was 93%. Angiographic follow-up was available for 42 patients and 101 lesions 9.5 +/- 5.8 months after PCI. The global restenosis rate was 36%. Multivariate analysis was used to assess 49 clinical, angiographic, and immunologic variables per lesion. The use of a cutting balloon increased the risk of restenosis (odds ratio 11.5, p <0.01) and the use of stents decreased the risk of restenosis (odds ratio 0.34, p <0.05) compared with other PCI methods. The restenosis rate with drug-eluting stents was 19%, lower than that with bare metal stents (31%). Of the 65 patients, 20 (31%) died within 1.9 +/- 1.8 years after PCI. The actuarial survival rate was 56% at 5 years after the first PCI. In conclusion, although the restenosis rate after PCI was higher than that in nontransplant patients with CAD, the immediate and long-term results were acceptable in this high-risk population. Despite the intense inflammation associated with transplant CAD, drug-eluting stents appeared to reduce the occurrence of restenosis. Compared with historical controls, PCI may also improve the actuarial survival rate of patients undergoing orthotopic heart transplantation.
