Coronary artery disease in heart transplant recipients - diagnosis and treatment. Single centre experience based on results of elective coronary angiography.
BACKGROUND
Despite recent progress in clinical transplantology, coronary artery disease of transplanted heart (TxCAD) remains the main cause of long-term mortality. The role of elective coronary angiography (CAG) and percutaneous coronary interventions (PCI) in these patients has not yet been well established.


OBJECTIVE
To evaluate the incidence of TxCAD based on the results of elective CAG and to assess the role of potential risk factors and treatment options.


METHODS
We analysed the results of 227 elective CAG procedures performed in 145 patients after orthotopic heart transplantation (OHT) between 1986 and 1998. The result of CAG was considered positive when any lesion was found in coronary arteries regardless of its hemodynamic relevance, including both atherosclerotic plaques and lesions characteristic of vasculopathy. The influence of immunological (rejection of transplanted heart) and non-immunological risk factors on the development of TxCAD was analysed separately for the first 3 years after OHT and for the subsequent period.


RESULTS
Positive result of at least one CAG was found in 54 (37%) patients. The overall percentage of positive CAG was 41%, starting from 18% one year after OHT to 55% five years after surgery. Vasculopathic lesions were found in 14% of CAG procedures. Risk factor analysis showed an increasing impact over time of non-immunological factors, however, differences were not statistically significant. Hemodynamically significant lesions were found in 21 patients. In 16 of those PCI was performed. Control CAG was done in 12 patients after PCI revealing indications for another PCI in 8 of them. TxCAD was the cause of death in 3 patients in the PCI group.


CONCLUSIONS
Based on the results of elective CAG, frequency of TxCAD increases with time and reaches 55% by 5 years after OHT. PCI is an effective method of treating significant coronary lesions after OHT.
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors