Long‐term clinical outcomes in patients treated with drug‐eluting compared to bare‐metal stents for the treatment of transplant coronary artery disease

Abstract

We aimed to compare the long-term clinical outcomes of first-vessel percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare metal stents (BMS) for the treatment of transplant coronary artery disease (TCAD). TCAD is the leading cause of late death in orthotopic heart transplantation (OHT) recipients. PCI is associated with worse clinical outcomes compared with non-OHT patients. Our institution previously reported superior angiographic outcomes with DES compared with BMS in OHT patients. However, long-term clinical outcomes comparing PCI with DES versus BMS are lacking. The data on 105 OHT recipients who underwent first-vessel PCI with DES (n = 58) or BMS (n = 47) at UCLA Medical Center between 1995 and 2009 were retrospectively analyzed. Five-year clinical outcomes were not significantly different with DES and BMS in terms of the composite of death, myocardial infarction (MI), or target vessel revascularization (TVR) [(40.8 ± 7.2)% vs. (59.6 ± 7.2)%, log-rank P = 0.33], death [(31.8 ± 7.8)% vs. (40.4 ± 7.2)%, log-rank P = 0.46], MI [(12.2 ± 6.2)% vs. (11.3 ± 5.4)%, log rank P = 0.98], TVR [(25.5 ± 6.9)% vs. (26.5 ± 7.3)%, log rank P = 0.76], and time to repeat OHT [(2.27 ± 1.79) vs. (3.22 ± 3.34), P = 0.98]. At long-term follow-up, PCI with DES and BMS provided similar clinical outcomes in OHT. Long-term mortality remains high in OHT recipients after PCI with either DES or BMS. Randomized clinical trials are required to determine the optimal treatment strategy for OHT recipients with TCAD.