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Early development of accelerated graft coronary artery disease: risk factors and course
S Z Gao1, S A Hunt, J S Schroeder
1Division of Cardiovascular Medicine, Stanford University School of Medicine, California 94305-5246, USA.
Insights
Early graft coronary artery disease in heart transplant recipients indicates more aggressive disease and is linked to cytomegalovirus infection. This suggests prioritizing early-onset patients for interventions to improve long-term survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Graft coronary artery disease (CAD) is a primary limitation to long-term survival post-heart transplantation.
- Understanding the natural history of graft CAD is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the timing of first angiographic graft CAD appearance in heart transplant recipients.
- To correlate graft CAD onset with clinical/laboratory variables, clinical events, and cytomegalovirus (CMV) infection.
Main Methods:
- Retrospective analysis of 139 heart transplant recipients with angiographic graft CAD.
- Classification into early (< or = 2 years) and late (> 2 years) onset groups.
- Comparison of clinical demographics, ischemic event progression, and CMV infection incidence.
Main Results:
- Early-onset graft CAD (n=64) showed more rapid progression to ischemic events compared to late-onset (n=75).
- By 5 years post-detection, 35% of early-onset and 59% of late-onset patients were event-free (p=0.02).
- The early-onset group had a significantly higher incidence of antecedent CMV infection.
Conclusions:
- Accelerated graft CAD occurs at variable times post-transplant.
- Early graft CAD may signify a more aggressive disease process.
- CMV infection is associated with earlier onset of graft CAD, suggesting potential for targeted interventions.
Objectives:
This study assessed the time of first appearance of angiographic graft coronary artery disease in relation to clinical and laboratory variables and clinical events in heart transplant recipients.
Background:
Graft coronary artery disease is the main factor limiting long-term survival after heart transplantation, and it is important to understand its natural history.
Methods:
One hundred thirty-nine consecutive patients who developed angiographic coronary artery disease after heart transplantation were classified according to early (< or = 2 years) versus late (> 2 years) posttransplantation initial detection of coronary artery disease. These subgroups were analyzed for differences in clinical and laboratory demographics, incidence of progression to ischemic events and incidence of antecedent cytomegalovirus infection.
Results:
The early-onset group (64 patients) had more rapid progression to ischemic events than the late-onset group (75 patients), with 59% of the late group and only 35% of the early group free from ischemic events by 5 years after initial detection (p = 0.02), but there were no significantly correlated clinical or laboratory predictors of ischemic events. The early group had a significantly higher incidence of antecedent cytomegalovirus infection.
Conclusions:
We conclude that 1) accelerated graft coronary artery disease develops at variable times after heart transplantation; 2) the early appearance of graft coronary artery disease may be a marker of intrinsically more aggressive disease; 3) cytomegalovirus infection is associated with earlier onset of graft coronary artery disease. Patients with early development of graft coronary artery disease should potentially be given priority for interventional strategies as they are developed.