Comparison of long-term results of drug-eluting stent and bare metal stent implantation in heart transplant recipients with coronary artery disease

Abstract

Background: Transplanted heart coronary artery disease (TxCAD) may occur in a significant proportion of patients following cardiac transplantation. Drug-eluting stents (DES) have been successfully used in patients with CAD, but their efficacy in TxCAD patients has not been well established.
Aim: To compare long-term results of intracoronary implantation of DES and BMS in patients suffering from TxCAD.
Methods: We performed a retrospective analysis of all intracoronary stent implantations for TxCAD with at least one control coronary angiography performed during follow-up. We identified 28 DES (all sirolimus-eluting stents, SES) and 28 BMS implantations in 23 patients. The mean follow-up time was 410 ± 58 days after DES, and 572 ± 434 days after BMS implantation (p = 0.004). We compared the occurrence of in-stent restenosis (ISR) in DES and BMS, and survival of patients in the context of risk factors that were identified for each stent implantation separately.
Results: There were 2 (7%) ISR revealed in DES patients (mean time from PCI to restenosis 492 ± 58 days) vs. 17 (61%) ISR in BMS patients (mean time from PCI to restenosis 475 ± 345 days) (p < 0.001). There were 3 (18%) deaths in patients with DES, 4 (31%) in patients with BMS, and 1 (14%) in a patient with DES and BMS (NS). The risk factor profile was comparable, except for higher age at the time of transplantation (46 ± 7 vs. 41 ± 6 years, p = 0.011) and stent implantation (54 ± 7 vs. 49 ± 6 years, p < 0.001) for DES.
Conclusion: Favourable long-term results of DES compared with BMS implantation for TxCAD suggest the preferential use of DES in heart transplant recipients.