Reduction of Cardiac Allograft Vasculopathy by PCI: Quantification and Correlation With Outcome After Heart...

Area of Science:

• Cardiology
• Transplantation Medicine
• Interventional Cardiology

Background:

• Cardiac allograft vasculopathy (CAV) is a major complication after heart transplantation (HTx).
• Percutaneous coronary intervention (PCI) may improve outcomes in severe CAV, but risk stratification post-PCI remains challenging.
• Existing risk models for non-transplanted patients may not fully apply to HTx patients with CAV.

Purpose of the Study:

• To evaluate the prognostic value of the International Society for Heart and Lung Transplantation (ISHLT) CAV classification after PCI.
• To determine if risk-stratification models used for non-transplanted patients are applicable to HTx patients with CAV.
• To assess the utility of SYNTAX scores in risk stratification post-PCI for CAV.

Main Methods:

• A study of 203 HTx patients with CAV, divided into two cohorts: CAV1 without PCI (n=126) and CAV2/3 with PCI (n=77).
• Assessment of ISHLT CAV grades, SYNTAX Score I (SXS-I), and SYNTAX Score II (SXS-II) at baseline and post-PCI (residual rISHLT, rSXS-I, rSXS-II).
• Incomplete revascularization (IR) was defined as rSXS-I > 0.

Main Results:

• SYNTAX Score II predicted mortality in the non-PCI cohort, while both SXS-I and SXS-II predicted mortality in the PCI cohort.
• Post-PCI, incomplete revascularization, high residual ISHLT (rISHLT), and the highest tertile of residual SXS-II were associated with increased 5-year mortality.
• Residual SXS-II and incomplete revascularization were significant predictors of 5-year mortality post-PCI.

Conclusions:

• The ISHLT CAV classification is applicable for risk stratification in HTx patients undergoing PCI.
• SYNTAX scores (SXS-I and SXS-II) can complement the ISHLT classification for enhanced risk stratification.
• These scores aid in individualizing invasive follow-up strategies for HTx patients with CAV post-PCI.