Poor prognosis for heart transplant patients with restenosis

By Piriya Mahendra

Orthotopic heart transplant patients (OHT) who develop in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) have a poor long-term prognosis, research suggests.

A retrospective study published in the American Journal of Cardiology revealed that heart transplant patients who had restenosis after PCI were less likely to experience freedom from a composite endpoint of mortality, myocardial infarction, or repeat OHT than those who did not experience restenosis, at incidence rates of 27.9% versus 63.2% (p=0.006).

This was primarily driven by a lower survival rate in patients with ISR than in those without, at 38.5% versus 84.2% (p<0.001).

Researchers say that the exact mechanism underlying the heightened risk for mortality and myocardial infarction in heart transplant patients who develop ISR is unknown.

In a press statement, lead author Michael Lee (University of California, Los Angeles, USA) remarked that organ rejection may contribute to the development of coronary artery disease and play a role in the increased risk for mortality. Intracoronary thrombus may also play a part, he added.

"We may find that development of restenosis in heart transplant patients may be a marker of a more aggressive inflammatory response and part of transplant rejection," he said.

For the study, Lee and team followed 105 heart transplant patients who underwent PCI with bare-metal stents or drug-eluting stents between 1995 and 2009. Of these, 83 (79%) patients underwent repeat angiography for clinical symptoms or surveillance.

ISR occurred in 26 (31.3%) patients who underwent follow-up angiography. Initial treatment strategies for these patients were target vessel revascularization (73.1%), repeat OHT (11.5%), and medical therapy (15.4%).

"The findings point to the need for improvements in prevention and treatment of transplant coronary artery disease that may help reduce restenosis for patients who require later cardiac procedures like stenting," commented Lee.

Further studies will aid understanding of the role of the various factors involved in the development of transplant coronary artery disease and ISR, he said.

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