Angiographic and clinical follow-up of percutaneous revascularization for transplant coronary artery disease

Background. There are limited data on the use of percutaneous revasculariza tion techniques for transplant coronary artery disease (CAD). Methods. Medical records and angiographic results for cardiac transplant pa tients undergoing percutaneous revascularization at Emery University Hospit al were reviewed. Procedural results, results of angiography 4-6 months aft er intervention, and clinical follow-up were recorded. Results. Nineteen patients underwent 51 interventions. Thirty-eight lesions (75%) were de novo and 13 (25%) were restenotic. All patients had hyperten sion, 37% had diabetes, 79% had elevated lipid levels, and 53% had at least one episode of moderate to severe allograft rejection (grade 3A or greater ). The primary procedural success rate was 100% with no major complications . Six-month restenosis rate (defined as > 50%) was 49%. At 23 +/- 17 months follow-up, 6 patients were dead or retransplanted (31%). Thirteen patients were alive without retransplantation (9 New York Heart Association class I , 3 class II, 1 class III). Conclusion. Percutaneous revascularization is safe and has a high initial p rocedural success rate in patients with transplant CAD. However, the resten osis rate in this population remains higher than reported for atherosclerot ic coronary disease and the long-term prognosis remains poor.