Division of Cardiology, University of California, Los Angeles, Medical Center, Los Angeles, California, USA.
Am J Cardiol. 2010 Oct 15;106(8):1086-9. doi: 10.1016/j.amjcard.2010.06.019.
The present study evaluated the safety and efficacy of percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (ULMCA) for the treatment of cardiac allograft vasculopathy (CAV) in consecutive unselected patients with orthotopic heart transplantation (OHT). PCI in patients with OHT and develop CAV has been associated with greater restenosis rates compared to PCI in patients with native coronary artery disease. A paucity of short- and long-term data is available from patients with OHT who have undergone PCI for ULMCA disease. The present retrospective, multicenter, international registry included 21 patients with OHT and CAV who underwent ULMCA PCI from 1997 to 2009. Angiographic success was achieved in all patients. Drug-eluting stents were used in 14 of the 21 patients. No major adverse cardiac events or repeat OHT occurred within the first 30 days. At a mean follow-up of 4.9 ± 3.2 years, 3 patients (14%) had died, myocardial infarction had occurred in 1 patient (5%), and target lesion revascularization had been required in 4 patients (19%). Follow-up angiography was performed in 16 patients (76%), and restenosis was observed in 4 (19%). No stent thrombosis of the ULMCA was observed. One patient (5%) underwent coronary artery bypass grafting, and 5 patients (24%) underwent repeat OHT. In conclusion, the results of our study have shown ULMCA PCI to be safe and reasonably effective in patients with OHT and represents a viable treatment strategy for CAV in these patients.
本研究评估了经皮冠状动脉介入治疗（PCI）在连续非选择性原位心脏移植（OHT）患者中的无保护左主干冠状动脉（ULMCA）治疗心脏移植后冠状动脉血管病（CAV）的安全性和疗效。与原发性冠状动脉疾病患者相比，OHT 患者发生 CAV 后 PCI 的再狭窄率更高。对于接受 PCI 治疗 ULMCA 疾病的 OHT 患者，目前仅有短期和长期数据。本回顾性、多中心、国际注册研究纳入了 1997 年至 2009 年接受 ULMCA PCI 的 21 例 OHT 合并 CAV 患者。所有患者均获得了血管造影成功。21 例患者中有 14 例使用了药物洗脱支架。在 30 天内，无重大不良心脏事件或再次 OHT 发生。平均随访 4.9±3.2 年后，3 例（14%）患者死亡，1 例（5%）患者发生心肌梗死，4 例（19%）患者需要靶病变血运重建。16 例患者（76%）进行了随访血管造影，发现 4 例（19%）患者存在再狭窄。未观察到 ULMCA 支架血栓形成。1 例（5%）患者接受了冠状动脉旁路移植术，5 例（24%）患者接受了再次 OHT。总之，我们的研究结果表明，对于 OHT 患者，ULMCA PCI 是安全且有效的，是治疗这些患者 CAV 的可行策略。
