title: Long-term outcome after bare-metal or drug-eluting stenting for allograft coronary artery disease.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) with bare-metal stenting (BMS) has been reported to be associated with high rates of target-lesion revascularization (TLR) in heart transplant recipients. We aimed to assess the outcome of successful PCI with BMS or drug-eluting stenting (DES) in such patients.
  
  
  METHODS
  Ninety-four consecutive heart transplant recipients with successful PCI of de novo lesions with BMS (n = 53) or DES (n = 60) were prospectively followed-up for 3.7 +/- 2.5 years after PCI. An angiographic lesion-based analysis at 12-month follow-up and a long-term, patient-based survival analysis were performed.
  
  
  RESULTS
  The lesion-based analysis within 12 months after PCI showed a reduction of TLR rates with the use of DES (6.6% vs 26.4%, p < 0.01). DES were associated with better preservation of left ventricular function at this time-point. The patient-based, long-term analysis showed sustained local benefit of DES (hazard ratio 4.5 [1.4 to 14.5] for BMS vs DES), but no effect on mortality, remote-site PCI and total revascularization rates. Anti-hypertensive (hazard ratio 0.2 [0.1 to 0.5]) and aspirin (hazard ratio 0.3 [0.1 to 0.8]) therapy, and left ventricular ejection fraction (0.96 [0.94 to 0.98] per percent) were the only correlates of long-term mortality.
  
  
  CONCLUSIONS
  Compared with BMS, DES are associated with a sustained reduction in rates of TLR and could safely be used in heart transplant recipients with coronary artery disease. Despite excellent local effects, DES use failed to reduce mortality. Anti-hypertensive and anti-platelet therapy, and left ventricular function preservation, may be considered as aims of treatment to improve long-term survival in such patients.
authors.affiliation: Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France. farzin.beygui@psl.aphp.fr
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Shaida
authors.initials: S
authors.lastname: Varnous
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Flor
authors.initials: F
authors.lastname: Fernandez
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Claude
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Metzger
authors.forename: Iradj
authors.initials: I
authors.lastname: Gandjbakhch
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D008670:Metals