Vol 61, No 10 (2004)
Other
Published online: 2005-12-12
Percutaneous coronary interventions in patients with transplanted heart coronary artery disease. Effects of intracoronary stent implantation on long-term results
DOI: 10.33963/v.kp.82018
Kardiol Pol 2004;61(10):344-348.
Abstract
Background: Transplanted heart coronary artery disease (TxCAD) is the most frequent casue of death occuring ≥5 years after orthotopic heart transplantation (OHT). Considering three basic therapeutic approaches - percutaneous coronary intervention (PCI), surgical revascularisation and retransplantation - PCI seems to be the superior method due to its safety and good short-term results, however, the long-term efficacy of PCI has been less well established.
Aim: To evaluate long-term results of PCI in the treatment of OHT recipients with TxCAD.
Methods: The study group consisted of 20 patients (19 males, aged 24-63, median 45.5 years; 14 (70%) had before OHT), who underwent single or multiple PCI of significant coronary lesions, revealed by elective (n=17) or urgent (n=3) coronary angiography (CAG). The overall number of PCI procedures was 26, including 8 with stent implantation. procedures were performed 9-151 (median 61.5) months after OHT. Analysis of PCI results was based on the follow-up CAGs or autopsy in case of death.
Results: Follow-up time was 3-90 (median 28) months. At least one CAG was performed in 17 (85%) patients - the overall number of follow-up CAGs was 53. Progression of TxCAD was revealed by 33 (62%) CAGs - the decision to perform subsequent single or multiple PCI was undertaken in 22 (42%) patients. The overall number of re-PCI procedures was 38 (with stent implantation in 11 cases). Out of 38 PCI procedures without stent implantation, significant restenosis was found on control CAG in 16 (42%) patients, and out of 16 PCI with stents - in 11 (69%) patients, including 8 haemodynamically significant lesions. TxCAD was the cause of 5 out of 9 deaths that occurred during follow-up.
Conclusions: PCI is unable to stop TxCAD development in the majority of patients. Stent implantation does not improve long-term results of TxCAD treatment.
Aim: To evaluate long-term results of PCI in the treatment of OHT recipients with TxCAD.
Methods: The study group consisted of 20 patients (19 males, aged 24-63, median 45.5 years; 14 (70%) had before OHT), who underwent single or multiple PCI of significant coronary lesions, revealed by elective (n=17) or urgent (n=3) coronary angiography (CAG). The overall number of PCI procedures was 26, including 8 with stent implantation. procedures were performed 9-151 (median 61.5) months after OHT. Analysis of PCI results was based on the follow-up CAGs or autopsy in case of death.
Results: Follow-up time was 3-90 (median 28) months. At least one CAG was performed in 17 (85%) patients - the overall number of follow-up CAGs was 53. Progression of TxCAD was revealed by 33 (62%) CAGs - the decision to perform subsequent single or multiple PCI was undertaken in 22 (42%) patients. The overall number of re-PCI procedures was 38 (with stent implantation in 11 cases). Out of 38 PCI procedures without stent implantation, significant restenosis was found on control CAG in 16 (42%) patients, and out of 16 PCI with stents - in 11 (69%) patients, including 8 haemodynamically significant lesions. TxCAD was the cause of 5 out of 9 deaths that occurred during follow-up.
Conclusions: PCI is unable to stop TxCAD development in the majority of patients. Stent implantation does not improve long-term results of TxCAD treatment.
Keywords: transplanted heart coronary artery disease - coronary angioplasty - stents - outcome
