Abstract 20003: The Impact of Percutaneous Coronary Intervention for Coronary Allograft Vasculopathy on Heart Transplant Survival in the UTAH Cardiac Program
Introduction: Cardiac allograft vasculopathy (CAV) is a leading cause of death in heart transplant recipients. The clinical benefits of percutaneous coronary intervention (PCI) for CAV are not well established. We sought to investigate the impact of PCI on the survival of heart transplant recipients with obstructive CAV.
Hypothesis: PCI would not have a positive impact on outcomes of patients with obstructive CAV
Methods: The records of 372 heart transplant recipients from the UTAH program between 1985 and 2012 were reviewed. These patients underwent 2110 coronary angiograms which were reviewed and graded based on the 2010 ISHLT classification. Patients were divided into three groups: group 1 included patients with CAV 0-1 , group 2 included patients with CAV ≥ 2 who underwent PCI, and group 3 included patients with CAV ≥ 2 who did not undergo PCI. The primary end-point was all cause mortality or retransplantation. The follow up time period was 3-30 years.
Results: The average age was 49±14 years, 81% were male. Baseline characteristics were comparable between groups 2 and 3. The incidence of obstructive CAV was 9% at 5years and 19% at 10 years. The number of lesions that underwent PCI (group 2) was comparable to the number of lesions that did not undergo PCI (group 3) in each major epicardial vessel. The indication for PCI was progressive asymptomatic CAV, graft failure, angina, and acute myocardial infarction in 57%, 23%, 16%, and 4% of the patients respectively. Heart transplant recipients with CAV≥2 had worse outcomes than those with CAV 0-1 (figure 1) (p<0.0001). In unadjusted analysis, PCI did not significantly improve survival of group 2 patients relative to group 3.
Conclusions: In this small single center study, the routine use of PCI in patients with obstructive CAV showed a trend towards improved survival, albeit not statistically significant. Further investigation is warranted to identify specific patients with CAV who may benefit from PCI.
Author Disclosures: A. Saidi: None. O. Wever-Pinzon: None. M. Gilbert: None. A. Tandar: None. J. Stehlik: None. C. Lui: None. R. Alharethi: None. S. Drakos: None. A. Abraham: None. T. Owan: None. J. Nativi-nicolau: None. B. Smith: None. A. Kfoury: None. J. Fang: None. F.G. Welt: None.
- © 2016 by American Heart Association, Inc.