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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Palliation of allograft vasculopathy with transluminal angioplasty

A decade of experience

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

^* Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
Department of Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA
Department of Surgery, Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA

Manuscript received March 3, 2003; revised manuscript received January 16, 2004, accepted January 27, 2004.

^* Reprint requests and correspondence: Dr. Raymond L. Benza, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 328A THT, 1900 University Boulevard, Birmingham, Alabama 35294-0006, USA.
rbenza{at}uab.edu

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.

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

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