Long-term results of angioplasty vs stenting in cardiac transplant recipients with allograft vasculopathy

Background: Allograft vasculopathy remains a major limiting factor in long-term graft survival. The absence of symptoms and diffuse nature of the disease make clinical detection and therapy more difficult. Limited data exist on the long-term outcome of percutaneous interventions in this group of patients. Methods: Medical records and cardiac catheterizations from the Cardiac Cath Lab database were retrospectively reviewed for all cardiac transplant recipients who had undergone a percutaneous intervention. Procedural results, complications, use of stents and angiographic follow-up were recorded. Re-stenosis was defined as a lesion > 50% in the target vessel at follow-up angiography. Results: Thirty-three patients underwent 97 percutaneous interventions with a mean of 2.9 interventions per patient. Mean age at the time of first intervention was 52 +/- 13 (mean +/- standard deviation) years. Mean time from transplant to first intervention was 5 +/- 3.0 years. The primary procedural success rate was 99%. Thirty-four procedures involved placement of a stent, 63 were angioplasty alone. There were no procedure-related complications. Seventy percent of lesions were de novo and 30% were re-stenotic lesions. Six-month, 12-month and 5-year target vessel re-stenosis rates in the stent group were 31%, 46% and 69%, and in the percutaneous transluminal coronary angioplasty (PTCA) group were 41%, 53% and 68%, respectively. Thirteen patients (39.3%) died or were re-transplanted, at 1.9 +/- 2.29 (mean SD) years after their first intervention. Twenty patients were alive at 4.5 +/- 2.99 years after the first intervention. Conclusions: Percutaneous intervention can be performed safely in cardiac transplant recipients. Stent placement reduces early and mid-term re-stenosis, but late re-stenosis occurs in 76% of lesions. Late re-stenosis, development of new coronary lesions, and need for repeat intervention are common, regardless of the method used for percutaneous intervention, emphasizing the diffuse and progressive nature of transplant coronary disease.