Percutaneous coronary intervention versus medical therapy for coronary allograft vasculopathy: One center’s experience
Coronary allograft vasculopathy, a rapidly progressive form of atherosclerosis, remains the limiting factor in the long-term survival of heart transplant recipients. Some centers have attempted percutaneous coronary intervention to slow the disease process and thereby reduce mortality in these patie...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2002-08, Vol.21 (8), p.860-866 |
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| container_title | The Journal of heart and lung transplantation |
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| creator | Aranda, Juan M Pauly, Daniel F Kerensky, Richard A Cleeton, Timothy S Walker, Tracy C Schofield, Richard S Leach, Dana Lin, Lang Monroe, V.Stephen Calderon, Rafael E Hill, James A |
| description | Coronary allograft vasculopathy, a rapidly progressive form of atherosclerosis, remains the limiting factor in the long-term survival of heart transplant recipients. Some centers have attempted percutaneous coronary intervention to slow the disease process and thereby reduce mortality in these patients, but long-term follow-up data are scarce. We compared clinical outcomes in heart transplant recipients with coronary allograft vasculopathy who were treated either with percutaneous coronary intervention or with aggressive medical therapy alone.
A retrospective analysis of all heart transplant recipients at our institution who underwent surveillance coronary angiography for coronary allograft vasculopathy between 1995 and 2000 was performed. Patients with coronary allograft vasculopathy were stratified according to whether they received medical therapy or percutaneous coronary intervention. Baseline demographics, results of re-vascularization procedures and outcomes were analyzed.
From 1995 to 2000, 301 patients underwent 602 coronary angiograms. Of the 79 patients who had angiographic evidence of coronary allograft vasculopathy, 53 were treated with aggressive medical therapy, while 26 underwent percutaneous coronary intervention in addition to aggressive medical therapy. At baseline, patients treated with aggressive medical therapy tended to be younger (54.6 ± 13.8 years) than patients treated with percutaneous coronary intervention (62.6 ± 7.6 years;
p = 0.0079). Ejection fraction at time of diagnosis of coronary allograft vasculopathy was similar for both groups (medical therapy group, 44.4 ± 13.4% vs percutaneous coronary intervention group, 47.2 ± 12.7%;
p = 0.38). In our cohort, heart transplant recipients with coronary allograft vasculopathy demonstrated greater mortality than heart transplant recipients without coronary allograft vasculopathy (
p = 0.016). Patients who underwent percutaneous coronary intervention had a 60% re-stenosis rate at 6 months if they were treated with coronary angioplasty and an 18% re-stenosis rate if they received a coronary stent. Kaplan–Meier analysis showed no significant difference in survival in either treatment group at 1 year (80% for medical therapy group vs 95% for percutaneous coronary intervention group) or 3 years (68% for medical therapy group vs 79% for percutaneous coronary intervention group) after the angiographic diagnosis of coronary allograft vasculopathy.
In this non-randomized trial, heart transplant |
| doi_str_mv | 10.1016/S1053-2498(02)00413-8 |
| format | Article |
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A retrospective analysis of all heart transplant recipients at our institution who underwent surveillance coronary angiography for coronary allograft vasculopathy between 1995 and 2000 was performed. Patients with coronary allograft vasculopathy were stratified according to whether they received medical therapy or percutaneous coronary intervention. Baseline demographics, results of re-vascularization procedures and outcomes were analyzed.
From 1995 to 2000, 301 patients underwent 602 coronary angiograms. Of the 79 patients who had angiographic evidence of coronary allograft vasculopathy, 53 were treated with aggressive medical therapy, while 26 underwent percutaneous coronary intervention in addition to aggressive medical therapy. At baseline, patients treated with aggressive medical therapy tended to be younger (54.6 ± 13.8 years) than patients treated with percutaneous coronary intervention (62.6 ± 7.6 years;
p = 0.0079). Ejection fraction at time of diagnosis of coronary allograft vasculopathy was similar for both groups (medical therapy group, 44.4 ± 13.4% vs percutaneous coronary intervention group, 47.2 ± 12.7%;
p = 0.38). In our cohort, heart transplant recipients with coronary allograft vasculopathy demonstrated greater mortality than heart transplant recipients without coronary allograft vasculopathy (
p = 0.016). Patients who underwent percutaneous coronary intervention had a 60% re-stenosis rate at 6 months if they were treated with coronary angioplasty and an 18% re-stenosis rate if they received a coronary stent. Kaplan–Meier analysis showed no significant difference in survival in either treatment group at 1 year (80% for medical therapy group vs 95% for percutaneous coronary intervention group) or 3 years (68% for medical therapy group vs 79% for percutaneous coronary intervention group) after the angiographic diagnosis of coronary allograft vasculopathy.
In this non-randomized trial, heart transplant recipients with coronary allograft vasculopathy were less likely to survive than patients without it. In addition, we found no statistical difference in mortality in heart transplant recipients with coronary allograft vasculopathy, regardless of whether they received percutaneous coronary intervention or aggressive medical therapy alone. J Heart Lung Transplant 2002;21:000–000.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/S1053-2498(02)00413-8</identifier><identifier>PMID: 12163085</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Biological and medical sciences ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Coronary Angiography ; Coronary Artery Disease - etiology ; Coronary Artery Disease - therapy ; Heart Transplantation - mortality ; Humans ; Medical sciences ; Middle Aged ; Postoperative Complications - therapy ; Retrospective Studies ; Stents ; Survival Analysis ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>The Journal of heart and lung transplantation, 2002-08, Vol.21 (8), p.860-866</ispartof><rights>2002 International Society for Heart and Lung Transplantation</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S1053-2498(02)00413-8$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13875121$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12163085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aranda, Juan M</creatorcontrib><creatorcontrib>Pauly, Daniel F</creatorcontrib><creatorcontrib>Kerensky, Richard A</creatorcontrib><creatorcontrib>Cleeton, Timothy S</creatorcontrib><creatorcontrib>Walker, Tracy C</creatorcontrib><creatorcontrib>Schofield, Richard S</creatorcontrib><creatorcontrib>Leach, Dana</creatorcontrib><creatorcontrib>Lin, Lang</creatorcontrib><creatorcontrib>Monroe, V.Stephen</creatorcontrib><creatorcontrib>Calderon, Rafael E</creatorcontrib><creatorcontrib>Hill, James A</creatorcontrib><title>Percutaneous coronary intervention versus medical therapy for coronary allograft vasculopathy: One center’s experience</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Coronary allograft vasculopathy, a rapidly progressive form of atherosclerosis, remains the limiting factor in the long-term survival of heart transplant recipients. Some centers have attempted percutaneous coronary intervention to slow the disease process and thereby reduce mortality in these patients, but long-term follow-up data are scarce. We compared clinical outcomes in heart transplant recipients with coronary allograft vasculopathy who were treated either with percutaneous coronary intervention or with aggressive medical therapy alone.
A retrospective analysis of all heart transplant recipients at our institution who underwent surveillance coronary angiography for coronary allograft vasculopathy between 1995 and 2000 was performed. Patients with coronary allograft vasculopathy were stratified according to whether they received medical therapy or percutaneous coronary intervention. Baseline demographics, results of re-vascularization procedures and outcomes were analyzed.
From 1995 to 2000, 301 patients underwent 602 coronary angiograms. Of the 79 patients who had angiographic evidence of coronary allograft vasculopathy, 53 were treated with aggressive medical therapy, while 26 underwent percutaneous coronary intervention in addition to aggressive medical therapy. At baseline, patients treated with aggressive medical therapy tended to be younger (54.6 ± 13.8 years) than patients treated with percutaneous coronary intervention (62.6 ± 7.6 years;
p = 0.0079). Ejection fraction at time of diagnosis of coronary allograft vasculopathy was similar for both groups (medical therapy group, 44.4 ± 13.4% vs percutaneous coronary intervention group, 47.2 ± 12.7%;
p = 0.38). In our cohort, heart transplant recipients with coronary allograft vasculopathy demonstrated greater mortality than heart transplant recipients without coronary allograft vasculopathy (
p = 0.016). Patients who underwent percutaneous coronary intervention had a 60% re-stenosis rate at 6 months if they were treated with coronary angioplasty and an 18% re-stenosis rate if they received a coronary stent. Kaplan–Meier analysis showed no significant difference in survival in either treatment group at 1 year (80% for medical therapy group vs 95% for percutaneous coronary intervention group) or 3 years (68% for medical therapy group vs 79% for percutaneous coronary intervention group) after the angiographic diagnosis of coronary allograft vasculopathy.
In this non-randomized trial, heart transplant recipients with coronary allograft vasculopathy were less likely to survive than patients without it. In addition, we found no statistical difference in mortality in heart transplant recipients with coronary allograft vasculopathy, regardless of whether they received percutaneous coronary intervention or aggressive medical therapy alone. J Heart Lung Transplant 2002;21:000–000.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Atherectomy, Coronary</subject><subject>Biological and medical sciences</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - etiology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Heart Transplantation - mortality</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications - therapy</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Survival Analysis</subject><subject>Transfusions. Complications. Transfusion reactions. 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Some centers have attempted percutaneous coronary intervention to slow the disease process and thereby reduce mortality in these patients, but long-term follow-up data are scarce. We compared clinical outcomes in heart transplant recipients with coronary allograft vasculopathy who were treated either with percutaneous coronary intervention or with aggressive medical therapy alone.
A retrospective analysis of all heart transplant recipients at our institution who underwent surveillance coronary angiography for coronary allograft vasculopathy between 1995 and 2000 was performed. Patients with coronary allograft vasculopathy were stratified according to whether they received medical therapy or percutaneous coronary intervention. Baseline demographics, results of re-vascularization procedures and outcomes were analyzed.
From 1995 to 2000, 301 patients underwent 602 coronary angiograms. Of the 79 patients who had angiographic evidence of coronary allograft vasculopathy, 53 were treated with aggressive medical therapy, while 26 underwent percutaneous coronary intervention in addition to aggressive medical therapy. At baseline, patients treated with aggressive medical therapy tended to be younger (54.6 ± 13.8 years) than patients treated with percutaneous coronary intervention (62.6 ± 7.6 years;
p = 0.0079). Ejection fraction at time of diagnosis of coronary allograft vasculopathy was similar for both groups (medical therapy group, 44.4 ± 13.4% vs percutaneous coronary intervention group, 47.2 ± 12.7%;
p = 0.38). In our cohort, heart transplant recipients with coronary allograft vasculopathy demonstrated greater mortality than heart transplant recipients without coronary allograft vasculopathy (
p = 0.016). Patients who underwent percutaneous coronary intervention had a 60% re-stenosis rate at 6 months if they were treated with coronary angioplasty and an 18% re-stenosis rate if they received a coronary stent. Kaplan–Meier analysis showed no significant difference in survival in either treatment group at 1 year (80% for medical therapy group vs 95% for percutaneous coronary intervention group) or 3 years (68% for medical therapy group vs 79% for percutaneous coronary intervention group) after the angiographic diagnosis of coronary allograft vasculopathy.
In this non-randomized trial, heart transplant recipients with coronary allograft vasculopathy were less likely to survive than patients without it. In addition, we found no statistical difference in mortality in heart transplant recipients with coronary allograft vasculopathy, regardless of whether they received percutaneous coronary intervention or aggressive medical therapy alone. J Heart Lung Transplant 2002;21:000–000.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>12163085</pmid><doi>10.1016/S1053-2498(02)00413-8</doi><tpages>7</tpages></addata></record> |
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| ispartof | The Journal of heart and lung transplantation, 2002-08, Vol.21 (8), p.860-866 |
| issn | 1053-2498 1557-3117 |
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| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Angioplasty, Balloon, Coronary Atherectomy, Coronary Biological and medical sciences Bone marrow, stem cells transplantation. Graft versus host reaction Coronary Angiography Coronary Artery Disease - etiology Coronary Artery Disease - therapy Heart Transplantation - mortality Humans Medical sciences Middle Aged Postoperative Complications - therapy Retrospective Studies Stents Survival Analysis Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Percutaneous coronary intervention versus medical therapy for coronary allograft vasculopathy: One center’s experience |
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