title: Outcomes of bare metal versus drug-eluting stents in allograft vasculopathy.
abstract: BACKGROUND
  Because of improved outcomes with drug-eluting stents (DES), we examined angiographic and clinical outcomes of bare metal stents (BMS) vs DES for discrete lesions in chronic allograft vasculopathy.
  
  
  METHODS
  Heart transplant patients who underwent percutaneous coronary intervention were divided into one of two groups: BMS or DES. Baseline clinical characteristics, rejection episodes and procedural details were compared. Distal arteriopathy was qualitatively compared using the Gao score. End-points included angiographic in-stent restenosis, acute coronary syndrome (ACS), ST-elevation myocardial infarction, heart failure admissions and cardiac death at 1 year. Student's t-test, chi-square test and the Mann-Whitney U-test were utilized to assess the results. Correlations were assessed using Pearson's correlation coefficient.
  
  
  RESULTS
  Forty-two patients with 80 stents (56 DES, 24 BMS) were identified. Baseline clinical characteristics, immunosuppression regimen, cardiac risk factors, frequency of rejection and procedural details were similar. Distal arteriopathy was similar (p = 0.374), suggesting equally advanced vasculopathy. Twenty-nine patients (69%) and 46 lesions (58%) were available at 1 year for clinical and angiographic follow-up. One-year diameter stenosis (26.1 +/- 21.3% vs 31.7 +/- 38.3%; p = 0.602) and binary restenosis (22.6% vs 22.7%; p = 0.774) rates were similar for DES and BMS, respectively. There were no ST-elevation infarctions; ACS [9 (16%) vs 5 (21%) p = 0.638] and cardiac death (2 in both groups) were similar for DES and BMS, respectively. Heart failure admissions were more frequent in the DES group [18 (32%) vs 5 (21%); p = 0.016]. No clinical predictors were identified.
  
  
  CONCLUSIONS
  In-stent stenosis, ACS and cardiac death at 1 year were similar for DES and BMS. The milieu of systemic immunosuppression in heart transplant decreases the advantages of DES in allograft vasculopathy.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Proddutur R
authors.initials: PR
authors.lastname: Reddy
authors.forename: Akhil
authors.initials: A
authors.lastname: Gulati
authors.forename: Lowell
authors.initials: L
authors.lastname: Steen
authors.forename: James
authors.initials: J
authors.lastname: Sinacore
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Leya
authors.forename: Alain
authors.initials: A
authors.lastname: Heroux
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000401:mortality; D054855:Drug-Eluting Stents; D004867:Equipment Design; D006333:Heart Failure / Q000453:epidemiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000601:surgery; D015607:Stents; D014184:Transplantation, Homologous; D016896:Treatment Outcome