Transplant coronary artery disease: Incidence, progression and interventional revascularization.
BACKGROUND
Allograft coronary artery disease (CAD) remains the main factor responsible for late graft loss. This analysis describes data on incidence and progression of allograft CAD at our institute, as well as our experience with coronary interventions in heart transplant recipients.


METHODS
Angiographic results of cardiac transplant patients undergoing coronary angiography were prospectively selected and analyzed. Angiographic outcome at follow-up were assessed for all coronary revascularizations in denovo lesions.


RESULTS
Four hundred thirty-two coronary angiographies were performed in a total of 246 patients. Seventy-six patients (30.9%) showed angiographic evidence of CAD with %DS>50%, of which 48 patients revealed significant stenosis with %DS>70% (19.5%). Within the first 5 years after the transplantation, 10.1% show angiographic signs of a CAD; at the time of 10.1 years, 50% of all heart transplant patients have developed a CAD. Once a CAD with %DS between 50% and 60% has evolved, the disease shows fast progression. Coronary intervention was performed in 28 vessels at an average time of 9.5 years after heart transplantation. Follow-up angiography was available for 27 vessels (1 death before re-angiography) within a mean follow-up period of 19.3 months. Binary restenosis was found in 7 out of 27 vessels (25.9%). Comparison of the occurrence of total occlusion in vessels with %DS>70% which were not revascularized to the occurrence of MACE after successful revascularization revealed better long term results in the group of patients with coronary intervention (p=0.04).


CONCLUSIONS
Whereas coronary artery disease is found in rare cases within the first 5 years after heart transplantation, the incidence grows in exponential manner after this period. Mid-term follow-up after coronary intervention exhibit restenosis-rates which are similar to the ones of other high risk patients. Comparison of coronary intervention versus conservative treatment in vessels with %DS>70% show significant better mid-term outcome in the interventional group.
Syeda
Bonni
B
Division of Cardiology, Department for Internal Medicine II, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. bonni.syeda@meduniwien.ac.at
Roedler
Suzanne
S
Schukro
Christoph
C
Yahya
Nabil
N
Zuckermann
Andreas
A
Glogar
Dietmar
D
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001317:Austria / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome