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Comparison of Percutaneous Coronary Intervention With Bare-Metal and Drug-Eluting Stents for Cardiac Allograft Vasculopathy

Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles

^_* Reprint requests and correspondence: Dr. Michael S. Lee, UCLA Medical Center, Adult Cardiac Catheterization Laboratory, 10833 Le Conte Avenue, Room BL-394 CHS, Los Angeles, California 90095-171715 (Email: mslee{at}mednet.ucla.edu).

Objectives: We sought to compare percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and drug-eluting stents (DES) for cardiac allograft vasculopathy (CAV).

Background: Cardiac allograft vasculopathy is a rapidly progressive form of atherosclerosis and is one of the main limitations to long-term survival after orthotopic heart transplantation. Percutaneous coronary intervention has been used as a palliative treatment option for CAV but is associated with worse clinical outcomes and greater rate of restenosis compared with PCI of native coronary arteries.

Methods: Between 1995 and 2007, data on 82 consecutive heart transplant patients who underwent PCI with BMS and DES at the University of California at Los Angeles Medical Center were retrospectively analyzed.

Results: A total of 82 lesions were treated with 98 BMS and 76 lesions were treated with 80 DES. Follow-up angiography was performed on 57 of 82 lesions (70%) treated with BMS and 58 of 76 (76%) treated with DES (p = 0.7) at a mean follow-up of 9.5 ± 5.5 months for BMS and 12.6 ± 8.2 months for DES (p = 0.02). Compared with BMS, DES was associated with a lower binary restenosis rate (12% vs. 30%, p = 0.02), lower percent diameter stenosis (24 ± 20 vs. 34 ± 36, p = 0.06), and less late lumen loss (0.24 ± 0.75 mm vs. 0.82 ± 1.03 mm, p = 0.01). No angiographic stent thrombosis was observed with DES.

Conclusions: When compared with BMS, PCI with DES was safe and reduced the rate of angiographic restenosis in patients with CAV. A randomized clinical trial comparing BMS versus DES with longer follow-up is needed to identify the optimal long-term revascularization strategy in patients with CAV.

Key Words: drug-eluting stent • percutaneous coronary intervention • cardiac transplantation

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CAV = cardiac allograft vasculopathy   DES = drug-eluting stent(s)   OHT = orthotopic heart transplantation   PCI = percutaneous coronary intervention

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