Prognosis of moderate coronary artery lesions in heart transplant patients.
BACKGROUND
Despite recent advances in our understanding of allograft vasculopathy, little is known about the evolution of moderate coronary lesions in heart transplant recipients.


METHODS
We retrospectively analyzed 58 heart transplant patients undergoing annual coronary angiography who demonstrated a moderate lesion (>30% and <60% diameter stenosis) on any routine annual study. In an attempt to find criteria that could distinguish such patients who were at high risk of disease progression from those at low risk, we reviewed the clinical and biologic features and angiographic and clinical outcomes of patients with and without lesion progression at 1 year.


RESULTS
Of the 58 patients who had an initially moderate coronary lesion, 28 (48%) showed progression of the lesion at angiography 1 year later (occlusion of the culprit vessel or progression to a severe lesion >60%) that required revascularization (angioplasty or bypass surgery). The 30 remaining patients showed no lesion progression. At the time of the first angiogram the only criterion which could predict lesion progression at 1 year was the presence of multi-vessel disease (p < 0.0001). Prognosis for these patients was poorer than in those with no disease progression, with a higher proportion of revascularization and sudden death (p < 0.001). Patients without lesion progression at 1 year had neither clinical events nor significant subsequent lesion progression during a mean follow-up of 6 years.


CONCLUSIONS
The presence of a moderate coronary stenosis in heart transplant patients justifies a repeat angiogram 1 year later. The use of percutaneous coronary angioplasty in such patients has not been validated, but may be an option to delay or prevent progression to coronary occlusion.
Luyt
Charles Edouard
CE
Cardiology, Pitié-Salpétrière Hospital, Paris, France.
Drobinski
Gérard
G
Dorent
Richard
R
Ghossoub
Jean-Jacques
JJ
Collet
Jean-Philippe
JP
Choussat
Rémi
R
Dalby
Miles
M
Thomas
Daniel
D
Gandjbakhch
Iradj
I
D016022:Case-Control Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D018450:Disease Progression; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
D007166:Immunosuppressive Agents