AJC: Transplant patients worse off when they develop in-stent restenosis
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Patients who undergo heart transplant and transplant coronary artery disease that develop into in-stent restenosis (ISR) post-PCI fare worse than those who don't, according to a restrospective study published June 18 in the American Journal of Cardiology (AJC).

“Transplant coronary artery disease (TCAD) commonly occurs after orthotopic heart transplantation (OHT), occurring in 32 percent of patients at five years and 53 percent at 10 years, and is a major cause of death and allograft loss after the first year after OHT,” wrote Michael S. Lee, MD, of UCLA Medical Center in Los Angeles, and colleagues.

To further explore this issue, Lee and colleagues conducted a retrospective study of 105 patients who underwent first-vessel PCI with either bare-metal stents (BMS) or drug-eluting stents (DES), to assess the long-term outcomes of patients undergoing heart transplant and TCAD and who developed ISR after PCI.

The authors aimed to understand the outcomes in TCAD patients who experience ISR after revascularization. They used data on patients with TCAD who underwent PCI with either BMS or DES at the UCLA Medical Center between 1996 and 2009. All patients with binary restenosis of more than 50 percent were evaluated.

ISR occurred in 26 of the 83 patients who underwent follow-up angiography. The median time it took for physicians to identify ISR was 282 days. In the 26 patients diagnosed with ISR, target vessel revascularization (TVR) was performed in 73.1 percent, repeat heart transplant was performed in 11.5 percent and medical therapy was used in 15.4 percent.

Of those who underwent TVR, brachytherapy was used in one patient, balloon angioplasty in one patient and CABG in one patient. Meanwhile, 16 of these patients underwent repeat stenting. Eleven patients underwent further repeat angiography post-TVR; 63.6 percent developed recurrent ISR.

"The findings point to the need for improvements in prevention and treatment of transplant coronary artery disease that may help reduce restenosis for patients who require later cardiac procedures like stenting,"  Lee said in a press release.

The mortality outlook was rather dismal in patients who developed restenosis when compared to those who did not, 38.5 percent vs. 84.2 percent, respectively.

"We may find that development of restenosis in heart transplant patients may be a marker of a more aggressive inflammatory response and part of transplant rejection," Lee summed.