A method of analyzing the onset and progression of coronary occlusive disease after transplantation and its effect on patient survival.
The development of transplant-acquired coronary occlusive disease is monitored with serial angiography and is graded on a three-point scale as normal, mild (< 50% stenosis), or severe (> or = 50% stenosis). Previous studies have provided information about the time to the first sign of disease on angiography or empirical descriptions of progression. The number of observed transitions between grades of disease has been recorded, and a Markov model based on these transitions is used to estimate the rate of progression through angiographically defined disease grades and the mortality rates from each grade. Five hundred thirty-six angiograms from 240 patients were analyzed. Fifty-three graft failures occurred. The annual transition rate per patient year from normal to mild disease was low, 0.120 (95% credible interval, 0.096 to 0.154), although the transition from mild to severe disease was relatively high, 0.482 (95% credible interval, 0.325 to 0.671). Annual death rates from normal, mild, and severe grades were 0.032 (95% credible interval, 0.016 to 0.052), 0.076 (95% credible interval, 0.007 to 0.187) and 0.415 (95% credible interval, 0.244 to 0.640), respectively. Before onset of disease patients have a hazard-free course, and mild disease displayed on angiography is relatively non-life-threatening. However, once mild disease has been detected by angiography, progression to severe disease is rapid, and severe disease carries a very poor prognosis.
Sharples
L D
LD
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, U.K.
Mullins
P A
PA
Cary
N R
NR
Large
S R
SR
Schofield
P M
PM
Wallwork
J
J
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate