CORONARY ANGIOPLASTY IN HEART-TRANSPLANT RECIPIENTS - A QUANTITATIVE ANGIOGRAPHIC LONG-TERM FOLLOW-UP-STUDY

Late morbidity and death as a result of transplant-related coronary va scular disease is a major unresolved problem for heart transplant reci pients. Treatment of discrete coronary lesions in transplanted coronar y arteries with angioplasty may be beneficial, but the long-term outco me and factors affecting restenosis are not known. To determine the ef fects of angioplasty on coronary caliber and the correlates of late re stenosis, we studied the results of 25 balloon angioplasty procedures for physiologically significant coronary artery stenosis (> 15 mm Hg t ranslesional pressure gradient) in nine heart transplant recipients. A ll patients underwent repeat coronary angiography within 6 months of a ngioplasty. Angiograms were analyzed by the Reiber-CAAS method of quan titative angiography. Procedural success rate was 100%, and there were no major complications. The minimum cross-sectional area of the lesio n increased from 0.8 +/- 0.5 mm2 to 3.1 +/- 1.7 mm2 immediately after dilation. Percent area stenosis decreased from 89% +/- 7% to 62% +/- 1 3%. Six (24%) of 25 lesions developed late physiologically significant restenosis, defined as greater than 15 mm Hg translesional pressure g radient, and 10 of 25 had angiographic restenosis, defined as 50% area stenosis by quantitative angiography. The loss in minimum cross-secti onal area of the lesion at late follow-up was related significantly to the minimum cross-sectional area (r = 0.67; p < 0.001) and percent ar ea stenosis (r = 0.62; p < 0.01) immediately after angioplasty and the gain in minimum area (r = 0.62; p < 0.01) or loss in percent area ste nosis (0.51%; p = 0.02) during the procedure. The loss in percent area stenosis at late follow-up was correlated significantly with percent area stenosis immediately after angioplasty (r = 0.67; p = 0.001) and the loss in percent area stenosis during the procedure (r = 0.59; p < 0.01). This preliminary experience suggests that angioplasty can be pe rformed safely and effectively in coronary arteries with transplant-re lated vasculopathy. The loss in lumenal caliber late after angioplasty , however, is related directly to the gain achieved during the procedu re.