title: Percutaneous coronary interventions and bypass surgery in patients with cardiac allograft vasculopathy: a single-center experience.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) remains a major impediment to long-term survival after heart transplantation (HT). Limited data exist regarding the impact of coronary revascularization in these patients.
  
  
  OBJECTIVE
  To evaluate the outcomes of revascularization procedures in patients with CAV compared with patients who did not undergo revascularization.
  
  
  METHODS
  Retrospective analysis of 249 patients who underwent HT at our center between June 1998 and December 2009 and who were examined by coronary angiography after HT. We included patients with moderate or severe CAV according to the International Society for Heart and Lung Transplantation (ISHLT) nomenclature to evaluated outcomes after revascularization or diagnostic angiography. Major adverse cardiovascular events (MACE) comprised death, acute coronary syndrome, coronary revascularization, admission because of heart failure not due to an acute rejection episode, and cardiac retransplantation.
  
  
  RESULTS
  Moderate or severe CAV was detected in 43 patients. Twelve (27.9%) underwent coronary revascularization: eight percutaneous interventions and four bypass surgeries. Indications for revascularization were symptomatic ischemia or noninvasive evidence of ischemia (n = 6, 14.0%) or high-risk asymptomatic CAV (n = 6; 14.0%), namely, lesions located in the left main or proximal anterior descending arteries or multivessel disease with left ventricular dysfunction. The remaining 31 (72.1%), who did not undergo revascularization showed an absence of ischemia during exercise echocardiography (n = 11; 25.6%) or diffuse disease not amenable to revascularization (n = 20; 46.5%). During a mean follow-up of 3.0 ± 2.4 years, MACE occurred in three revascularized patients (25.0%), in one with absence of stress-induced ischemia (9.1%) and in 13 with nonrevascularizable disease (65%; P = .012).
  
  
  CONCLUSIONS
  Revascularization procedures were effective in HT patients with evidence of ischemia or high-risk CAV. Patients with absence of stress-induced ischemia have a good prognosis without revascularization. On the other hand, diffuse nonrevascularizable CAV is associated with a poor prognosis.
authors.affiliation: Transplant and Advanced Heart Failure Unit, Division of Cardiology, Complejo Hospitalario Universitario A Coruña, Spain. Oscar.Prada.Delgado@sergas.es
authors.forename: O
authors.initials: O
authors.lastname: Prada-Delgado
authors.forename: R
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.forename: A
authors.initials: A
authors.lastname: López-Sainz
authors.forename: P
authors.initials: P
authors.lastname: Gargallo-Fernández
authors.forename: M J
authors.initials: MJ
authors.lastname: Paniagua-Martín
authors.forename: R
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.forename: E
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: J J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
authors.forename: A
authors.initials: A
authors.lastname: Castro-Beiras
authors.forename: M G
authors.initials: MG
authors.lastname: Crespo-Leiro
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome