A decade of percutaneous coronary interventions in cardiac transplant recipients: a monocentric study in 160 patients.
BACKGROUND
Transplant vasculopathy is a long-term complication of cardiac transplantation. Percutaneous transluminal coronary angioplasty (PCI) is a method of choice for local revascularization that is also increasingly used in heart transplant patients.


METHODS
Between October 1989 and November 2006, 160 adult cardiac transplant recipients (19 women) with mean age at heart transplantation of 47 +/- 12 years underwent PCI in 502 coronary segments during 319 catheterizations (balloon only, 209; bare metal stents, 227, drug-eluting stents, 66). Concomitant medical therapy, procedural data, primary success, recurrence of stenosis, and cardiac events (cardiac death or repeat transplantation) were analyzed retrospectively. Multivariate Cox proportional hazards analysis was performed.


RESULTS
Stents reduced early and mid-term recurrence of stenosis but had no impact on graft survival. Drug-eluting stents did not improve the restenosis rate. Immunosuppression with mycophenolate mofetil and concomitant treatment with statins and clopidogrel were significantly associated with reduced recurrence of stenosis and prolonged graft survival. Low steroid dosage was associated with a positive impact on graft survival.


CONCLUSIONS
Stenting in heart transplant patients has no impact on graft survival despite high primary success and deferred recurrence of stenosis. Early reduction of steroids, immunosuppression by mycophenolate mofetil, and concomitant treatment with statins are likely to reduce recurrent stenosis and to improve graft survival in heart transplant patients needing PCI. Long-term treatment with clopidogrel deserves further assessment.
Wellnhofer
Ernst
E
Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. Ewellnhofer@t-online.de
Hiemann
Nicola E
NE
Hug
Jürgen
J
Dreysse
Stefan
S
Knosalla
Christoph
C
Graf
Kristof
K
Meyer
Rudolph
R
Lehmkuhl
Hans B
HB
Hetzer
Roland
R
Fleck
Eckart
E
D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000706:statistics & numerical data; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006084:Graft Rejection / Q000188:drug therapy; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents