Abstract 3044: Percutaneous Revascularization of Transplant Coronary Disease Carries a High Restenosis Rate that is Reduced by Drug-Eluting Stents
Background: Transplant coronary artery disease (TCAD) remains the major cause of graft failure and mortality after cardiac transplantation. The pathogenesis involves diffuse and multifocal myointimal hyperplasia.
Hypothesis: Percutaneous coronary intervention (PCI) carries a high restenosis rate that might be reduced by drug-eluting stents.
Methods: Retrospective analysis of heart transplantation patients undergoing PCI at our institution between March 1995 and May 2006.
Results: Twenty-four patients underwent PCI on 64 de-novo lesions. Four (16.7%) were females and 14 (58.3%) had diabetes. The mean age of the patients at the time of transplantation was 52.8±11.7 years (range 19.5 – 66). The mean time from transplantation to PCI was 8.3±3.6 years (range 0.9 – 18.4). The distribution of the lesions was as follows: left main 1; left anterior descending 32; circumflex 16; right coronary artery 15. PCI success was achieved in 58 (90.6%) lesions. Angiographic follow up was available for 51 lesions at 13.2±16.8 months (range 0.9 – 85.3). The overall binary restenosis rate (BRR) was 64.7% during the period of follow up. The 1- year BRR, available for 44 lesions, was 65.9%. This was significantly lower for lesions treated with drug-eluting stents (N=5, BRR = 20%), compared to bare-metal stents (N=21, BRR = 57.1%) and balloon angioplasty (N=18, BRR = 88.9%). [Chi-squared for trend, p=0.0019]. PCI performed on 16 restenotic lesions using balloon angioplasty (N=7) and bare-metal stents (N=9) had a 1-year BRR of 68.7%. In the overall sample, LV ejection fraction by echocardiography did not change between the time of PCI (55.5±14.5%, range 30 – 84) and follow up (55.2±13.7%, range 24 – 78) [p=NS; 2-tailed paired t-test]. The same remained true when the analysis was limited to non-restenotic lesions [p=NS], as well as those with baseline LV ejection fraction < 50% [p=NS]. The actuarial survival rate at 5 years following PCI was 50%.
Conclusion: In patients with transplant vasculopathy, PCI can be performed with a high success rate, but is associated with a high restenosis rate that is reduced with the use of drug-eluting stents. The LV systolic function does not change significantly following interventions on epicardial vessels.