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Coronary angioplasty in heart transplant recipients: a quantitative angiographic long-term follow-up study
B V Christensen1, S M Meyer, C L Iacarella
1Department of Medicine, University of Minnesota, Minneapolis 55455.
Insights
Balloon angioplasty successfully treated coronary artery stenosis in heart transplant recipients, but restenosis remains a concern. Factors like immediate post-procedure stenosis influence long-term outcomes.
Area of Science:
- Cardiology
- Transplant Medicine
- Vascular Biology
Background:
- Coronary vascular disease is a significant cause of morbidity and mortality in heart transplant recipients.
- The efficacy and long-term outcomes of angioplasty for coronary lesions in transplanted arteries are not well-established.
Purpose of the Study:
- To evaluate the effects of balloon angioplasty on coronary artery caliber in heart transplant recipients.
- To identify factors associated with late restenosis after angioplasty of transplanted coronary arteries.
Main Methods:
- Twenty-five balloon angioplasty procedures were performed for significant coronary artery stenosis in nine heart transplant recipients.
- Quantitative angiography (Reiber-CAAS) was used to analyze coronary angiograms before and after angioplasty, and at 6-month follow-up.
Main Results:
- Procedural success rate was 100% with no major complications.
- Angioplasty significantly increased minimum cross-sectional area and decreased percent area stenosis immediately post-procedure.
- Late restenosis occurred in 24% of lesions (physiologically significant) and 40% (angiographically defined).
- Loss of minimum cross-sectional area at follow-up correlated significantly with immediate post-angioplasty measurements and procedural changes.
Conclusions:
- Balloon angioplasty is a safe and effective initial treatment for coronary artery stenosis in heart transplant recipients.
- Immediate post-angioplasty results and procedural changes are significant predictors of late restenosis, highlighting the need for further research into prevention strategies.
Abstract:
Late morbidity and death as a result of transplant-related coronary vascular disease is a major unresolved problem for heart transplant recipients. Treatment of discrete coronary lesions in transplanted coronary arteries with angioplasty may be beneficial, but the long-term outcome and factors affecting restenosis are not known. To determine the effects of angioplasty on coronary caliber and the correlates of late restenosis, we studied the results of 25 balloon angioplasty procedures for physiologically significant coronary artery stenosis (> 15 mm Hg translesional pressure gradient) in nine heart transplant recipients. All patients underwent repeat coronary angiography within 6 months of angioplasty. Angiograms were analyzed by the Reiber-CAAS method of quantitative angiography. Procedural success rate was 100%, and there were no major complications. The minimum cross-sectional area of the lesion increased from 0.8 +/- 0.5 mm2 to 3.1 +/- 1.7 mm2 immediately after dilation. Percent area stenosis decreased from 89% +/- 7% to 62% +/- 13%. Six (24%) of 25 lesions developed late physiologically significant restenosis, defined as greater than 15 mm Hg translesional pressure gradient, and 10 of 25 had angiographic restenosis, defined as 50% area stenosis by quantitative angiography. The loss in minimum cross-sectional area of the lesion at late follow-up was related significantly to the minimum cross-sectional area (r = 0.67; p < 0.001) and percent area stenosis (r = 0.62; p < 0.01) immediately after angioplasty and the gain in minimum area (r = 0.62; p < 0.01) or loss in percent area stenosis (0.51%; p = 0.02) during the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)