Accelerated transplant vasculopathy portends proliferative restenosis after percutaneous coronary intervention in cardiac transplant patients

Abstract

Background: Allograft vasculopathy (AV) after cardiac transplant (TX) causes diffuse concentric narrowing. Percutaneous intervention(PCI) is widely used in treating AV. We evaluated l-year clinical and quantitative angiographic (QCA) results of PCI in TX pts. Methods: 432 pts underwent TX at Brigham &Women’s Hospital from Feb 1984 to Aug 2001. Oi these, 24 (92% male, mean age 55 yrs) underwent PCI of 49 lesions. Core-lab QCA determined % diameter stenosis (LX?), reference (RD) and minimal lumen (MLD) diameters. Results: Procedural success was 98.0%. Of 24 pts, 5 (21%) died within lyear of PCI. QCA of 24 PCI lesions in 14 pts (74%) with l-year follow up revealed preprocedure: (RD 2.61*0.23mm. MLD 0.39*0.28mm, % DS 85.1ill.O) and post procedure: (RD 2.74+0.25mm, MLD 2.27*0.38mm. % DS 17.6+8.9, acute gain 1.88+0.47mm). One year follow up showed(RD 2.59*0.22mm, MLD 1.25*0.80mm. % DS 52.0t29.6) a Late Loss (LL) of 1.02r0.82mm and loss index of 0.55iO.43. Restenosis (DS>50%) occurred in 11(46%) lesions. Seventeen matched AV lesions(DS 28.2y&l1.4) at a nonPCI site had a LL of 0.66+0.38mm. Pts with restenosis also had greater LL at the nonintervened matched site than patients without restenosis(0.94*0.36mm vs 0.40*0.16mm, p=O.O03). Patient-specific LL at PCI and non-PC1 sites correlated significantly (r=O.65, p=O.OOl, figure) Conclusions: PCI in TX pts has high procedural success. Restenosis rates are high in pts with rapid progression of AV suggesting common mechanisms