title: Percutaneous coronary interventions in patients with transplanted heart coronary artery disease. Effects of intracoronary stent implantation on long-term results.
abstract: BACKGROUND
  Transplanted heart coronary artery disease (TxCAD) is the most frequent casue of death occuring > or =5 years after orthotopic heart transplantation (OHT). Considering three basic therapeutic approaches - percutaneous coronary intervention (PCI), surgical revascularisation and retransplantation - PCI seems to be the superior method due to its safety and good short-term results, however, the long-term efficacy of PCI has been less well established.
  
  
  OBJECTIVE
  To evaluate long-term results of PCI in the treatment of OHT recipients with TxCAD.
  
  
  METHODS
  The study group consisted of 20 patients (19 males, aged 24-63, median 45.5 years; 14 (70%) had before OHT), who underwent single or multiple PCI of significant coronary lesions, revealed by elective (n=17) or urgent (n=3) coronary angiography (CAG). The overall number of PCI procedures was 26, including 8 with stent implantation. procedures were performed 9-151 (median 61.5) months after OHT. Analysis of PCI results was based on the follow-up CAGs or autopsy in case of death.
  
  
  RESULTS
  Follow-up time was 3-90 (median 28) months. At least one CAG was performed in 17 (85%) patients - the overall number of follow-up CAGs was 53. Progression of TxCAD was revealed by 33 (62%) CAGs - the decision to perform subsequent single or multiple PCI was undertaken in 22 (42%) patients. The overall number of re-PCI procedures was 38 (with stent implantation in 11 cases). Out of 38 PCI procedures without stent implantation, significant restenosis was found on control CAG in 16 (42%) patients, and out of 16 PCI with stents -- in 11 (69%) patients, including 8 haemodynamically significant lesions. TxCAD was the cause of 5 out of 9 deaths that occurred during follow-up.
  
  
  CONCLUSIONS
  PCI is unable to stop TxCAD development in the majority of patients. Stent implantation does not improve long-term results of TxCAD treatment.
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Disease, Zabrze.
authors.forename: Michał
authors.initials: M
authors.lastname: Zakliczyński
authors.forename: Marcin
authors.initials: M
authors.lastname: Swierad
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lekston
authors.forename: Marcin
authors.initials: M
authors.lastname: Maruszewski
authors.forename: Helena
authors.initials: H
authors.lastname: Zakliczyńska
authors.forename: Anna
authors.initials: A
authors.lastname: Barańska-Kosakowska
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents