Comparison of percutaneous coronary intervention with bare-metal and drug-eluting stents for cardiac allograft vasculopathy.
OBJECTIVE
We sought to compare percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and drug-eluting stents (DES) for cardiac allograft vasculopathy (CAV).


BACKGROUND
Cardiac allograft vasculopathy is a rapidly progressive form of atherosclerosis and is one of the main limitations to long-term survival after orthotopic heart transplantation. Percutaneous coronary intervention has been used as a palliative treatment option for CAV but is associated with worse clinical outcomes and greater rate of restenosis compared with PCI of native coronary arteries.


METHODS
Between 1995 and 2007, data on 82 consecutive heart transplant patients who underwent PCI with BMS and DES at the University of California at Los Angeles Medical Center were retrospectively analyzed.


RESULTS
A total of 82 lesions were treated with 98 BMS and 76 lesions were treated with 80 DES. Follow-up angiography was performed on 57 of 82 lesions (70%) treated with BMS and 58 of 76 (76%) treated with DES (p = 0.7) at a mean follow-up of 9.5 +/- 5.5 months for BMS and 12.6 +/- 8.2 months for DES (p = 0.02). Compared with BMS, DES was associated with a lower binary restenosis rate (12% vs. 30%, p = 0.02), lower percent diameter stenosis (24 +/- 20 vs. 34 +/- 36, p = 0.06), and less late lumen loss (0.24 +/- 0.75 mm vs. 0.82 +/- 1.03 mm, p = 0.01). No angiographic stent thrombosis was observed with DES.


CONCLUSIONS
When compared with BMS, PCI with DES was safe and reduced the rate of angiographic restenosis in patients with CAV. A randomized clinical trial comparing BMS versus DES with longer follow-up is needed to identify the optimal long-term revascularization strategy in patients with CAV.
Lee
Michael S
MS
Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. mslee@mednet.ucla.edu
Kobashigawa
Jon
J
Tobis
Jonathan
J
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015141:Los Angeles; D008297:Male; D008670:Metals; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D008670:Metals