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 70% 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.