Palliation of allograft vasculopathy with transluminal angioplasty: A decade of experience

Raymond L. Benza, Gilbert J. Zoghbi, Jose Tallaj, Robert Brown, James K. Kirklin, Meloneysa Hubbard, Barry Rayburn, Brian Foley, David C. McGiffin, Laura J. Pinderski, Vijay Misra, Robert C. Bourge

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Abstract

Objectives The goal of this study was to examine the outcomes of percutaneous coronary interventions (PCI) and the predictors for restenosis after cardiac transplantation. Background The role of PCI as definitive therapy for allograft coronary disease (ACD) remains contentious. Methods Between January 1, 1990 and December 31, 2000, 62 patients (1.5 to 15.5 years after transplant) underwent 151 procedures resulting in PCIs of 219 lesions. Follow-up after PCI angiography was usually obtained at three and six months, then yearly. Repeat PCI was routinely done to lesions with >60% restenosis. Results The primary procedural success was 97%. Repeat PCI occurred in 74 of 219 lesions (34%); PCI-related mortality was 2.6% (4 of 151). The freedom from re-PCI (of same vessel site) was 75% at six months, 65% at one year, and 57% at four years. The freedom from restenosis was 95% at one month, 81% at three months, and 57% at six months. Multivariate predictors of freedom from restenosis were the use of stents, higher anti-proliferative immunosuppressant dose, and an era effect. In the setting of one-vessel disease at first PCI, the two-year freedom for ACD death or graft loss was 74%, compared with 75% for two-vessel and 27% for three-vessel disease (p = 0.009). Conclusions Despite the increasing effectiveness of PCI for localized ACD, the survival after development of advanced ACD remains poor. Stents appear to increase effectiveness of PCI for ACD, but other factors in the current era contribute to improved outcomes.

Original languageEnglish
Pages (from-to)1973-1981
Number of pages9
JournalJournal of the American College of Cardiology
Volume43
Issue number11
DOIs
Publication statusPublished - 2 Jun 2004
Externally publishedYes

Keywords

  • ACD
  • allograft coronary disease
  • anti-proliferative
  • AP
  • CAD
  • coronary artery disease
  • minimal luminal diameter
  • MLD
  • MMF
  • mycophenolate mofetil
  • PCI
  • percutaneous coronary intervention
  • percutaneous transluminal coronary angioplasty
  • PTCA

Cite this

Benza, R. L., Zoghbi, G. J., Tallaj, J., Brown, R., Kirklin, J. K., Hubbard, M., Rayburn, B., Foley, B., McGiffin, D. C., Pinderski, L. J., Misra, V., & Bourge, R. C. (2004). Palliation of allograft vasculopathy with transluminal angioplasty: A decade of experience. Journal of the American College of Cardiology, 43(11), 1973-1981. https://doi.org/10.1016/j.jacc.2004.02.045