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Long-term outcome after bare-metal or drug-eluting stenting for allograft coronary artery disease.

Authors
  • Beygui, Farzin1
  • Varnous, Shaida
  • Montalescot, Gilles
  • Fernandez, Flor
  • Collet, Jean-Philippe
  • Leprince, Pascal
  • Le Feuvre, Claude
  • Pavie, Alain
  • Komajda, Michel
  • Metzger, Jean-Philippe
  • Gandjbakhch, Iradj
  • 1 Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France. [email protected] , (France)
Type
Published Article
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Publication Date
Mar 01, 2010
Volume
29
Issue
3
Pages
316–322
Identifiers
DOI: 10.1016/j.healun.2009.08.020
PMID: 19837605
Source
Medline
Language
English
License
Unknown

Abstract

Percutaneous coronary intervention (PCI) with bare-metal stenting (BMS) has been reported to be associated with high rates of target-lesion revascularization (TLR) in heart transplant recipients. We aimed to assess the outcome of successful PCI with BMS or drug-eluting stenting (DES) in such patients. Ninety-four consecutive heart transplant recipients with successful PCI of de novo lesions with BMS (n = 53) or DES (n = 60) were prospectively followed-up for 3.7 +/- 2.5 years after PCI. An angiographic lesion-based analysis at 12-month follow-up and a long-term, patient-based survival analysis were performed. The lesion-based analysis within 12 months after PCI showed a reduction of TLR rates with the use of DES (6.6% vs 26.4%, p < 0.01). DES were associated with better preservation of left ventricular function at this time-point. The patient-based, long-term analysis showed sustained local benefit of DES (hazard ratio 4.5 [1.4 to 14.5] for BMS vs DES), but no effect on mortality, remote-site PCI and total revascularization rates. Anti-hypertensive (hazard ratio 0.2 [0.1 to 0.5]) and aspirin (hazard ratio 0.3 [0.1 to 0.8]) therapy, and left ventricular ejection fraction (0.96 [0.94 to 0.98] per percent) were the only correlates of long-term mortality. Compared with BMS, DES are associated with a sustained reduction in rates of TLR and could safely be used in heart transplant recipients with coronary artery disease. Despite excellent local effects, DES use failed to reduce mortality. Anti-hypertensive and anti-platelet therapy, and left ventricular function preservation, may be considered as aims of treatment to improve long-term survival in such patients.

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