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Coronary revascularization after heart transplant - the search for prognostic factors
Bartlomiej Guzik1, Elżbieta Szczepanek1, Łukasz Niewiara1
1Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Insights
Heart transplant recipients undergoing percutaneous coronary intervention (PCI) had worse survival initially, but this difference disappeared after adjusting for comorbidities. Chronic kidney disease was a significant mortality predictor, and HTX patients experienced more severe bleeding.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Background:
- Improved survival after heart transplantation (HTX) allows coronary artery vasculopathy to develop.
- Clinical outcomes of cardiac transplant patients undergoing percutaneous coronary intervention (PCI) require further exploration.
Purpose of the Study:
- To assess if heart transplantation compromises outcomes in patients undergoing PCI.
- To evaluate survival rates and major cardiovascular complications in heart transplant recipients post-PCI.
Main Methods:
- A single-center study matched 33 heart transplant recipients who underwent PCI (2005-2015) with 33 controls.
- Patients were matched for age, sex, and major arteriosclerosis risk factors.
- Median time from HTX to PCI was 13 years; chronic kidney disease was more prevalent in HTX patients (70%) versus controls.
Main Results:
- Heart transplant recipients showed worse unadjusted survival (p=0.04).
- After adjusting for comorbidities, no significant survival difference was observed between HTX patients and controls (HR=1.06).
- Chronic renal disease independently predicted all-cause mortality (HR=29.9), and HTX patients had higher severe bleeding rates (27% vs. 3%, p<0.05).
Conclusions:
- No significant differences in myocardial infarction, revascularization, or hospitalization rates were found between groups.
- While unadjusted survival was worse in heart transplant recipients, adjusted analysis revealed comparable outcomes.
- Severe bleeding is a notable complication in heart transplant patients undergoing PCI.
Introduction:
Survival after heart transplantation (HTX) is extended due to continuous improvement of medical care, allowing enough time for coronary artery vasculopathy to develop. Data on the clinical outcome of cardiac transplantation patients after percutaneous coronary intervention (PCI) are still not extensively explored. The aim of our study was to assess whether heart transplantation itself compromises the outcome in patients undergoing percutaneous coronary intervention and to assess survival rates as well as major cardiovascular complications in heart transplant recipients who had undergone PCI.
Material And Methods:
Thirty-three heart transplant recipients who had undergone PCI in the years 2005 to 2015 in a single center were matched by age, sex and main risk factors of arteriosclerosis with 33 controls without heart transplant history. Mean age of patients was 54.6 ±11.4 years in the HTX group and 58.8 ±10.8 years in controls. Median time from heart transplant to PCI was 13 years (4.4-22 years). Case and control groups did not differ in terms of standard risk factors of coronary artery disease, apart from chronic kidney disease, which was present in 70% of patients after heart transplantation, and dyslipidemia, which was present in 91% of control subjects.
Results:
Patients after HTX had worse survival compared to controls (p = 0.04). When adjusted for comorbidities in the Cox regression model, there was no significant difference in survival between cardiac transplant recipients and the control group (HR = 1.06; 95% CI: 0.10-11.24). Chronic renal disease was a significant predictor of all-cause mortality (HR = 29.9; 95% CI: 2.3-393). Considering other endpoints, HTX patients had considerably higher incidence of severe bleeding compared to the control group (27% vs. 3%, p < 0.05).
Conclusions:
There was no significant difference in myocardial infarction rate, revascularization or hospitalization rates.
