title: Drug-eluting stents may not reduce target lesion revascularization in cardiac allograft vasculopathy.
abstract: OBJECTIVE
  Although drug-eluting stent (DES) compared with bare metal stent (BMS) use reduces in-stent restenosis (ISR) in traditional coronary artery disease, its efficacy in cardiac allograft vasculopathy (CAV) has not been clearly established.
  
  
  BACKGROUND
  CAV is a leading cause of mortality after the first year following cardiac transplantation. CAV treatment options are limited, and DES use has increased significantly in this population.
  
  
  METHODS
  In a retrospective study of heart transplant patients at our institution who underwent percutaneous coronary intervention with a BMS or DES for CAV, we compared baseline characteristics, clinical outcomes, ISR, and target lesion revascularization (TLR). The primary end-point was angiographic ISR assessed by quantitative coronary angiography analyzed as both a binary (≤50% vs. >50%) and continuous variable (follow-up minimal luminal area [MLA]/baseline MLA). Secondary outcomes included TLR and a composite of death, myocardial infarction, heart failure, and retransplantation.
  
  
  RESULTS
  In 45 patients with DES, BMS, or both, ISR assessed as a continuous variable was statistically different between the 2 stent groups (follow-up MLA/baseline MLA = 0.796 DES vs. 0.481 BMS; P = 0.0037). There was also a significant difference in ISR (10.8% for DES versus 30.7% for BMS) when assessed as a binary variable. There was no statistically significant difference in TLR or composite cardiovascular outcomes between groups when adjusted for traditional cardiovascular risk factors.
  
  
  CONCLUSIONS
  ISR assessed as a continuous variable was significantly different between stent groups. However, this did not lead to a difference in TLR or cardiovascular outcomes. This hypothesis-generating finding suggests that patients with CAV may not necessarily need treatment with DES, which can be more costly and carries more potential risk than BMS.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Ki E
authors.initials: KE
authors.lastname: Park
authors.forename: Tianyao
authors.initials: T
authors.lastname: Huo
authors.forename: Keith E
authors.initials: KE
authors.lastname: Muller
authors.forename: Juan M
authors.initials: JM
authors.lastname: Aranda
authors.forename: James A
authors.initials: JA
authors.lastname: Hill
authors.forename: R David
authors.initials: RD
authors.lastname: Anderson
mesh_terms: D064591:Allografts; D003327:Coronary Disease / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents