Coronary artery diseaseValue of Drug-Eluting Stents in Cardiac Transplant Recipients
Section snippets
Methods
We retrospectively reviewed the charts of all cardiac transplant recipients (n = 32) from Columbia University Medical Center, New York, New York, who were treated sequentially with DESs for TAV from April 2003 onward, when sirolimus-eluting stents (SESs) became available. A historic cohort2 of patients (n = 35) who sequentially received BMSs was used for comparison. Additionally, a second comparator control group of age- and gender-matched transplant recipients (n = 355) without obstructive
Results
Of a population of 1,628 transplant recipients, 32 patients underwent implantation of DESs from February 2004 to August 2007. Patient characteristics are listed in Table 1. Average age at transplantation was 46 years, and ¼ of patients were women. Sixteen patients underwent transplantation for nonischemic cardiomyopathy, and 16 patients, for ischemic cardiomyopathy. Prevalences of diabetes (34%) and hypertension (82%) were high, and 75% of patients were receiving treatment with statins.
Discussion
This study examined the use of DESs as a treatment for patients with TAV. Although the cohort of patients with DESs had less in-stent restenosis (18.6%) than the cohort of patients who received BMSs (49%), risk-adjusted survival in the 2 groups of patients was similar. When TAV requiring PCI has developed, the 1-year mortality rate was 32% and the 2-year mortality rate was 41%, indicating a particularly grim prognosis. Therefore, stent implantation with DESs did not appear to alter the
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Cited by (22)
First- Versus New-Generation Drug-Eluting Stents in Patients With Heart Transplant With Cardiac Allograft Vasculopathy
2023, American Journal of CardiologyCitation Excerpt :In a more recent study, where patients who underwent PCI were mainly treated with DES, Agarwal et al28 observed a greater long-term survival for patients amenable to and treated with PCI than those with severe CAV not treatable with percutaneous myocardial revascularization, pointing out the beneficial role of PCI in this setting when appropriately performed. Several studies comparing the efficacy of I-DES versus bare-metal stents in the context of PCI for CAV reported a lower rate of in-stent restenosis with I-DES both at 1-year and at longer follow-up.7–12 However, no clinical benefits in terms of death and MACE were observed.12
Potential Mechanisms of Stent Thrombosis
2018, The Interventional Cardiac Catheterization HandbookCurrent Status of Heart Transplantation
2014, Regenerative Medicine Applications in Organ TransplantationDiagnosis, prevention and treatment of cardiac allograft vasculopathy
2012, Revista Portuguesa de CardiologiaLong-term outcomes of heart transplantation recipients with transplant coronary artery disease who develop in-stent restenosis after percutaneous coronary intervention
2012, American Journal of CardiologyCitation Excerpt :Treatment with drug-eluting stents was a negative predictor of the composite end point. Previous studies have demonstrated that drug-eluting stents are associated with lower restenosis rates compared to bare-metal stents and may explain the lower incidence of adverse clinical events.4,13,14 Treatment with statins was identified as a negative predictor of the composite end point.
Dr. Moses was supported by Cordis, Warren, New Jersey, the manufacturer of Cypher, and is on the advisory board for MIV Therapeutics, Vancouver, Canada, and Caliber Therapeutics, Boston, Massachusetts. Dr. Leon is on the scientific advisory board for Abbott Vascular Santa Clara, California, Boston Scientific Corporation, Natick, Massachusetts, Cordis, and Medtronic Vascular, Santa Clara, California. Dr. Kirtane received an honorarium from Boston Scientific and Medtronic Vascular and was a consultant/SAB/Speakers' Bureau for Abbott Vascular and received lecture fees/consultant.