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Article
Comparing long-term outcomes between drug-eluting and bare-metal stents in the treatment of cardiac allograft vasculopathy
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
  • Tonga Nfor, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care
  • Imran Ansaarie, Aurora Health Care
  • Anjan Gupta, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health
  • Tanvir Bajwa, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • Suhail Allaqaband, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care
Aurora Affiliations
Division of Medicine, Aurora Sinai Medical Center, Department of Cardiology, Aurora St. Luke’s Medical Center
Publication Date
10-1-2009
Abstract

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of death after the first year following heart transplantation. We compared restenosis rates, mortality, and other major adverse cardiac events (MACE) between transplant recipients treated with DES and BMS for CAV.

METHODS: All patients from our heart transplant registry undergoing PCI with stenting for CAV were identified. Procedural data, baseline clinical characteristics, yearly coronary angiography, cardiac events and death were prospectively collected. Primary outcome was in-stent restenosis (ISR). Secondary outcomes were in-segment restenosis, target vessel revascularization (TVR), all-cause mortality and combined MACE.

RESULTS: 36 lesions in 25 patients treated with DES were compared with 31 BMS-treated lesions in 19 patients. There were no significant differences in baseline characteristics. 12-month incidence of ISR was 0% with DES vs. 12.9% with BMS, P = 0.03. Over mean (+/-standard error) follow-up of 51.1 +/- 7.5 months this difference was significant for vessels < or =3 mm in diameter, hazard ratio (HR) DES vs. BMS 0.37 (95% CI 0.11 to 0.95) P = 0.037; but not for vessels >3 mm P = 0.45. However, there was no difference in overall longterm patency because of similar rates of in-segment restenosis between DES and BMS, HR 1.13 (95% CI 0.43 to 2.97) P = 0.81. Also, the rates of TVR, death from any cause and combined MACE were similar; log rank P 0.88, 0.67, and 0.85, respectively.

CONCLUSION: This study suggests that after PCI for cardiac allograft vasculopathy, despite a lower in-stent restenosis rate in DES compared with BMS, in-segment restenosis and clinical cardiac endpoints are similar.

Document Type
Article
PubMed ID
19405161
DOI
10.1002/ccd.22058
Citation Information
Nfor T, Ansaarie I, Gupta A, Bajwa T, Allaqaband S. Comparing long-term outcomes between drug-eluting and bare-metal stents in the treatment of cardiac allograft vasculopathy. Catheter Cardiovasc Interv. 2009 Oct 1;74(4):543-9.