Graft coronary artery disease is strongly related to the aetiology of heart failure and cellular rejections

Aims To identify risk factors for the development of coronary artery diseas e after heart transplantation. Methods and Results In consecutive heart transplanted patients, who underwe nt coronary angiography at the first year follow-up, the aetiology of heart failure in 113 was ischaemic heart disease or dilated cardiomyopathy. Deve lopment of clinically significant graft coronary artery disease was analyse d vs recipient and donor pre- and posttransplantation variables. At 1, 5 an d 9 years follow-up, coronary artery disease had developed in 4%, 16%, and 20% of the included patients, respectively. Among patients with ischaemic h eart disease as the aetiology of heart failure, 38% developed graft coronar y artery disease, while the corresponding figure for patients with dilated cardiomyopathy was 9% (P<0.001) during 9 years of follow-up. In multivariat e regression analysis, the aetiology of ischaemic heart disease and the num ber of cellular rejections were independent predictors of developing graft coronary artery disease, with risk ratios of 5.8, (95% confidence interval of 2.2-14.8 (P=0.0003)) and 3.3, (95% confidence interval of 1.7-6.5 (P=0.0 004)), respectively. Classical risk factors for coronary artery disease did not influence the development of graft coronary artery disease. Conclusions Ischaemic heart disease as the aetiology of heart failure and t he number of cellular rejections were powerful independent predictors of de velopment of graft coronary artery disease following heart transplantation. The low incidence of graft coronary artery disease among patients with dil ated cardiomyopathy implies that coronary angiography after heart transplan tation can be made on a more selective basis.