DOES RAPIDITY OF DEVELOPMENT OF TRANSPLANT CORONARY-ARTERY DISEASE PORTEND A WORSE PROGNOSIS

We postulated that transplant coronary artery disease with rapid progr ession to more than 50% stenosis within a 1-year interval may have a d ifferent prognosis from transplant coronary artery disease with a more indolent rate of progression. Annual coronary angiograms of 139 conse cutive patients who underwent transplantation between January 1968 and February 1990 who survived at least 1 year after transplantation and in whom angiographically apparent transplant coronary artery disease d eveloped were included in the study. Of this group, 45 patients progre ssed from a normal angiogram to the presence of 50% or greater stenosi s in one or more major vessels within 1 year (fulminant group); 94 did not (indolent group). Mean posttransplantation follow-up time was 5.3 +/- 4.1 years for patients with fulminant progression of disease and 6.6 +/- 3.7 years for those with indolent progression. A highly signif icant difference was found in the time-related incidence of ischemic e vents (myocardial infarction, congestive heart failure, sudden death, and retransplantation) between the indolent and the fulminant groups a fter initial detection of transplant coronary artery disease. At 1, 3, and 5 years after initial detection of transplant coronary artery dis ease, 50%, 33%, and 16% of patients in the fulminant group and 89%, 70 %, and 60% of patients in the indolent group were free of ischemic eve nts (p < 0.0001). The fulminant group of patients had a mean of 2.9 +/ - 1.5 rejection episodes, and the indolent group a mean of 2.3 +/- 1.4 episodes (p = 0.02) during the first year after transplantation. Main tenance prednisone dose was higher for the fulminant group than for th e indolent group (0.32 +/- 0.13 versus 0.23 +/- 0.13 mg/kg/day; p = 0. 04). Other clinical and laboratory data did not differ significantly b etween the two groups. Rapid or fulminant development of transplant co ronary artery disease within 1 year does portend a poor prognosis for major clinical events. This fact may be useful in making decisions abo ut listing for elective retransplantation.