Reduction of Cardiac Allograft Vasculopathy by PCI: Quantification and Correlation With Outcome After Heart Transplantation.

• Risk stratification of heart transplanted patients with cardiac allograft vasculopathy (CAV) after percutaneous coronary intervention (PCI) remains challenging. • The CAV classification nomenclature of the International Society of Heart and Lung Transplantation (ISHLT) could apply for risk stratification after PCI. • SYNTAX-scores I and II could be complemental for risk stratification and individualization of invasive follow-up of patients after heart transplantation with CAV, before and after PCI. Percutaneous coronary intervention (PCI) might improve outcome at severe stages of cardiac allograft vasculopathy (CAV) among patients after heart transplantation (HTx). Yet, risk stratification of HTx patients after PCI remains challenging. To assess whether the International Society for Heart and Lung Transplantation (ISHLT) CAV classification remains prognostic after PCI and whether risk-stratification models of non-transplanted patients extend to HTx patients with CAV. At 2 European academic centers, 203 patients were stratified in cohort 1 (ISHLT CAV1, without PCI, n = 126) or cohort 2 (ISHLT CAV2 and 3, with PCI). At first diagnosis of CAV or first PCI, respectively, ISHLT CAV grades, SYNTAX scores I and II (SXS-I, SXS-II) were used to quantify baseline and residual CAV (rISHLT, rSXS-I, rSXS-II). RSXS-I > 0 defined incomplete revascularization (IR). SXS-II predicted mortality in cohort 1 (P = 0.004), whereas SXS-I (P = 0.009) and SXS-II (P = 0.002) predicted mortality in cohort 2. Post-PCI, IR (P = 0.004), high rISHLT (P = 0.02) and highest tertile of rSXS-II (P = 0.006) were associated with higher 5-year mortality. In bivariable Cox analysis, baseline SXS-II, IR and rSXS-II remained predictors of 5-year mortality post-PCI. There was a strong inverse relationship between baseline and rSXS-I (r = -0.55; P < 0.001 and r = -0.50; P = 0.003, respectively) regarding the interval to first reintervention. People with ISHLT CAV classification could apply for risk stratification after PCI. SYNTAX scores could be complemental for risk stratification and individualization of invasive follow-up of HTx patients with CAV. [Display omitted] Visual Take-Home Graphic Kaplan-Meier curves of post-procedural scores for the endpoint of overall mortality (above) and reintervention (below) in patients after heart transplantation with severe cardiac allograft vasculopathy at 5 years after first PCI. 1, Freedom from overall mortality: 1, A, Freedom from mortality according to residual ISHLT CAV grades. 1, B, Freedom from overall mortality according to dichotomization in complete vs incomplete revascularization (residual SYNTAX score I = 0 vs residual SYNTAX score I > 0).1, C, Freedom from overall mortality according to the tertiles of residual SYNTAX score II. 2, Freedom from reintervention: 2, A, Freedom from reintervention according to residual ISHLT CAV grades. 2, B, Freedom from reintervention according to dichotomization in complete vs incomplete revascularization (residual SYNTAX score I = 0 vs residual SYNTAX score I > 0). 2, C, Freedom from reintervention according to dichotomization in presence of diffuse narrowing vs no presence of diffuse narrowing. P values of log-rank tests are shown. CAV, cardiac allograft vasculopathy; ISHLT, International Society for Heart and Lung Transplantation; rISHLT grade, residual CAV grade according to ISHLT nomenclature; SXS, SYNTAX score; rSXS, residual SYNTAX score; PCI, percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]