Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience.
OBJECTIVE
The goal of this study was to examine the outcomes of percutaneous coronary interventions (PCI) and the predictors for restenosis after cardiac transplantation.


BACKGROUND
The role of PCI as definitive therapy for allograft coronary disease (ACD) remains contentious.


METHODS
Between January 1, 1990 and December 31, 2000, 62 patients (1.5 to 15.5 years after transplant) underwent 151 procedures resulting in PCIs of 219 lesions. Follow-up after PCI angiography was usually obtained at three and six months, then yearly. Repeat PCI was routinely done to lesions with >60% restenosis.


RESULTS
The primary procedural success was 97%. Repeat PCI occurred in 74 of 219 lesions (34%); PCI-related mortality was 2.6% (4 of 151). The freedom from re-PCI (of same vessel site) was 75% at six months, 65% at one year, and 57% at four years. The freedom from restenosis was 95% at one month, 81% at three months, and 57% at six months. Multivariate predictors of freedom from restenosis were the use of stents, higher anti-proliferative immunosuppressant dose, and an era effect. In the setting of one-vessel disease at first PCI, the two-year freedom for ACD death or graft loss was 74%, compared with 75% for two-vessel and 27% for three-vessel disease (p = 0.009).


CONCLUSIONS
Despite the increasing effectiveness of PCI for localized ACD, the survival after development of advanced ACD remains poor. Stents appear to increase effectiveness of PCI for ACD, but other factors in the current era contribute to improved outcomes.
Benza
Raymond L
RL
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. rbenza@uab.edu
Zoghbi
Gilbert J
GJ
Tallaj
Jose
J
Brown
Robert
R
Kirklin
James K
JK
Hubbard
Meloneysa
M
Rayburn
Barry
B
Foley
Brian
B
McGiffin
David C
DC
Pinderski
Laura J
LJ
Misra
Vijay
V
Bourge
Robert C
RC
D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000473:pathology*; D016896:Treatment Outcome