Nfor Tonga, Ansaarie Imran, Gupta Anjan, Bajwa Tanvir, Allaqaband Suhail
Aurora Sinai Medical Center, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
Catheter Cardiovasc Interv. 2009 Oct 1;74(4):543-9. doi: 10.1002/ccd.22058.
Cardiac allograft vasculopathy (CAV) is the leading cause of death after the first year following heart transplantation. We compared restenosis rates, mortality, and other major adverse cardiac events (MACE) between transplant recipients treated with DES and BMS for CAV.
All patients from our heart transplant registry undergoing PCI with stenting for CAV were identified. Procedural data, baseline clinical characteristics, yearly coronary angiography, cardiac events and death were prospectively collected. Primary outcome was in-stent restenosis (ISR). Secondary outcomes were in-segment restenosis, target vessel revascularization (TVR), all-cause mortality and combined MACE.
36 lesions in 25 patients treated with DES were compared with 31 BMS-treated lesions in 19 patients. There were no significant differences in baseline characteristics. 12-month incidence of ISR was 0% with DES vs. 12.9% with BMS, P = 0.03. Over mean (+/-standard error) follow-up of 51.1 +/- 7.5 months this difference was significant for vessels < or =3 mm in diameter, hazard ratio (HR) DES vs. BMS 0.37 (95% CI 0.11 to 0.95) P = 0.037; but not for vessels >3 mm P = 0.45. However, there was no difference in overall longterm patency because of similar rates of in-segment restenosis between DES and BMS, HR 1.13 (95% CI 0.43 to 2.97) P = 0.81. Also, the rates of TVR, death from any cause and combined MACE were similar; log rank P 0.88, 0.67, and 0.85, respectively.
This study suggests that after PCI for cardiac allograft vasculopathy, despite a lower in-stent restenosis rate in DES compared with BMS, in-segment restenosis and clinical cardiac endpoints are similar.
心脏移植血管病变（CAV）是心脏移植术后第一年之后的主要死亡原因。我们比较了接受药物洗脱支架（DES）和裸金属支架（BMS）治疗CAV的移植受者的再狭窄率、死亡率及其他主要不良心脏事件（MACE）。
从我们的心脏移植登记处识别出所有因CAV接受经皮冠状动脉介入治疗（PCI）并植入支架的患者。前瞻性收集手术数据、基线临床特征、年度冠状动脉造影、心脏事件及死亡情况。主要结局为支架内再狭窄（ISR）。次要结局为节段内再狭窄、靶血管重建（TVR）、全因死亡率及合并的MACE。
比较了25例接受DES治疗患者的36处病变与19例接受BMS治疗患者的31处病变。基线特征无显著差异。DES组12个月时ISR发生率为0%，BMS组为12.9%，P = 0.03。在平均（±标准误）51.1±7.5个月的随访中，对于直径≤3 mm的血管，这种差异具有统计学意义，DES组与BMS组的风险比（HR）为0.37（95%CI 0.11至0.95），P = 0.037；而对于直径>3 mm的血管则无差异，P = 0.45。然而，由于DES和BMS的节段内再狭窄率相似，总体长期通畅率无差异，HR为1.13（95%CI 0.43至2.97），P = 0.81。此外，TVR、任何原因导致的死亡及合并MACE的发生率也相似；对数秩检验P值分别为0.88、0.67和0.85。
本研究表明，对于心脏移植血管病变进行PCI治疗后，尽管DES组的支架内再狭窄率低于BMS组，但节段内再狭窄及临床心脏终点相似。
