Survival benefit in heart transplant recipients who have coronary artery disease confirmed using angiography and are receiving sirolimus.
BACKGROUND
The aim of this study was to assess efficacy and safety of sirolimus (SIR) in heart transplant recipients to prevent further development of coronary artery disease (TxCAD) already confirmed by using coronary angiography.


METHODS
We performed a retrospective case-control study involving all 60 heart transplant recipients receiving SIR in a number of combinations with other immunosuppressive drugs, and 60 matched individuals after heart transplantation treated without SIR. TxCAD was diagnosed using elective coronary angiography in 9 subjects in the study group (8 males and 1 female) of mean age 44 +/- 11 years, including ischemic cardiomyopathy in 4 members. The control group of 15 individuals 15 males of mean age 47 +/- 7 years, including ischemic cardiomyopathy in 8. We compared time to develop significant TxCAD and death caused by TxCAD, and all-cause deaths. Significance was assessed using log-rank and chi-square tests, when applicable.


RESULTS
Significant TxCAD (critical coronary lesions, myocardial infarction or death) was observed in 5 (56%) patients receiving SIR and 11 (73%) without SIR (P = not significant [NS]). Time to develop significant TxCAD was comparable. There were 2 (22%) deaths in the SIR group and 8 (53%) in the control group (P = NS). Survival time was significantly longer among subjects receiving SIR (P = .02). None of deaths in the study group was caused by TxCAD compared with 6 (40%) deaths among controls (P = .09). Time of freedom from death caused by TxCAD was significantly longer in the study group (P = .023).


CONCLUSIONS
SIR prolonged survival in heart transplant recipients with TxCAD confirmed using coronary angiography.
Zakliczynski
M
M
Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
Swierad
M
M
Nozynski
J
J
Maruszewski
M
M
Zembala
M
M
D000328:Adult; D016022:Case-Control Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery*; D003643:Death; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000276:immunology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016019:Survival Analysis; D017741:Survivors; D055815:Young Adult
D007166:Immunosuppressive Agents; D020123:Sirolimus