Author + information
- Silvia Vilches-Soria1,
- Juan Francisco Oteo Dominguez2,
- Ebrey León Aliz3,
- Carlos Arellano Flores2,
- Javier Lopez-Pais2,
- Jorge Manuel Solano López Morel2,
- Arturo Garcia-Touchard2,
- Jose Antonio Fernandez Diaz1,
- Javier Goicolea2 and
- Javier Segovia-Cubero2
Cardiac allograft vasculopathy (CAV) affects 50% of cardiac transplants in long-term follow-up. Percutaneous coronary intervention (PCI) is a treatment option, but few studies show great benefit and most of them show high restenosis rates and target lesion revascularization (TLR).The aim of this study is to review our experience using stents in percutaneous coronary interventions in cardiac allograft vasculopathy.
We studied retrospectively 38 patients with CAV treated with PCI from 2000 to 2017. Surveillance angiography was performed in 85% of stents. Stent restenosis (SR), stent thrombosis (ST), target lesion revascularization (TLR) and patient survival are reported.
One-hundred and two stents were placed in 96 lesions: 16 bare-metal stent (BMS), 34 first-generation drug-eluting stent (FDES), 52 second and third generation drug-eluting stent (SDES). Primary success was obtained in 99% of lesions. 6% of stents were placed in left main coronary artery, 43% in left anterior descending coronary artery, 28% in circumflex coronary artery, and 23% in right coronary artery. Pre-PCI stenosis was 75.5 ± 13.2%, average stent length 20.2 ± 7 mm and average stent diameter 2.8 ± 0.5 mm. Mean time from transplantation to PCI was 11.5 ± 5 years. Mean clinical follow-up was 5.3± 4.4 years. Mean angiographic follow-up was 40 ± 47 months. A total of 27 (31%) stents presented events during follow-up: 27 SR, no ST. 7 occurred in BMS, 9 in FDES, 11 in SDES (p=0.4). There were no difference in rate of SR between BMS and DES (44% vs 39%, p=0.24). We performed 15 (17.2%) TLR. Post-PCI survival was 72.7% at 5 and 50.3% at 10 years, and freedom from lesion SR and/or ST was 96% at 1, 57% at 5 and 47% at 10 years.
In cardiac transplant recipients, PCI with stent can be performed with high rates of primary success. Our series show a low rate of SR at 1-year-follow-up, similar to coronary disease in non-transplant patients. However, after a very long-term follow-up, the rate of SR is still high.
CORONARY: PCI Outcomes