title: Persistent mild lesions in coronary angiography predict poor long-term survival of heart transplant recipients.
abstract: BACKGROUND
  Even though coronary angiography (CAG) underestimates coronary allograft vasculopathy (CAV) development, especially in the distal parts of arteries, it remains a frame of reference for International Society for Heart and Lung Transplantation (ISHLT) CAV classification. A retrospective analysis was performed to assess the prognostic value of CAG findings.
  
  
  METHODS
  Among 310 orthotopic heart transplantation (OHT) recipients with at least 2 CAGs at 2-year intervals, we identified 197 (146 men and 41 women; 55 ± 13 years) without lesions (Group 0), 27 (15 men and 12 women; 58 ± 8 years) in whom mild changes remained in consecutive CAGs (Group 1), 28 (24 men and 4 women; 58 ± 10 years) in whom mild lesions decreased in consecutive CAGs (Group 1REG), and 58 (53 men and 5 women; 56 ± 10 years) in whom the stenosis criteria of ISHLT CAV 2 or 3 were covered (Group 2). We compared survival and other clinical variables among the groups.
  
  
  RESULTS
  The average follow-up was 10 ± 4 years. Forty-one (21%) deaths occurred in Group 0, 15 (56%) in Group 1 (p = 0.002), 9(31%) in Group 1REG (p = NS), and 26 (46%) in Group 2 (p = 0.004, chi-square test). Time free from all-cause death was significantly shorter in Group 1 (T1/2 = 8 years) than in Group 0 (T1/2 = 15.5 years; p = 0.00072, log-rank test). Time free from cardiovascular death was significantly shorter in Groups 1 and 2, as was time free from CAV-related death in Groups 1, 1REG, and 2. Multivariate analysis, using a Cox proportional hazards model, revealed that Group 1 inclusion criterion of CAG findings is an independent predictor of all-cause death, cardiovascular death, and CAV-related death.
  
  
  CONCLUSIONS
  Persistent mild coronary lesions, observed in consecutive CAG, predicted shorter survival of OHT recipients.
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland. Electronic address: m.zakliczynski@sccs.pl.
authors.forename: Michael
authors.initials: M
authors.lastname: Zakliczynski
authors.affiliation: Faculty of Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Babinska
authors.affiliation: Faculty of Medicine in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Bozena
authors.initials: B
authors.lastname: Flak
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Nozynski
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kamienska
authors.affiliation: 3rd Department of Cardiology at the Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Bozena
authors.initials: B
authors.lastname: Szygula-Jurkiewicz
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pacholewicz
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.affiliation: Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Disease, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: coronary allograft vasculopathy; coronary angiography; coronary lesions; heart transplantation; long-term survival