Document Detail


Comparison of percutaneous coronary intervention with bare-metal and drug-eluting stents for cardiac allograft vasculopathy.
MedLine Citation:
PMID:  19463388     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to compare percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and drug-eluting stents (DES) for cardiac allograft vasculopathy (CAV).
BACKGROUND: Cardiac allograft vasculopathy is a rapidly progressive form of atherosclerosis and is one of the main limitations to long-term survival after orthotopic heart transplantation. Percutaneous coronary intervention has been used as a palliative treatment option for CAV but is associated with worse clinical outcomes and greater rate of restenosis compared with PCI of native coronary arteries.
METHODS: Between 1995 and 2007, data on 82 consecutive heart transplant patients who underwent PCI with BMS and DES at the University of California at Los Angeles Medical Center were retrospectively analyzed.
RESULTS: A total of 82 lesions were treated with 98 BMS and 76 lesions were treated with 80 DES. Follow-up angiography was performed on 57 of 82 lesions (70%) treated with BMS and 58 of 76 (76%) treated with DES (p = 0.7) at a mean follow-up of 9.5 +/- 5.5 months for BMS and 12.6 +/- 8.2 months for DES (p = 0.02). Compared with BMS, DES was associated with a lower binary restenosis rate (12% vs. 30%, p = 0.02), lower percent diameter stenosis (24 +/- 20 vs. 34 +/- 36, p = 0.06), and less late lumen loss (0.24 +/- 0.75 mm vs. 0.82 +/- 1.03 mm, p = 0.01). No angiographic stent thrombosis was observed with DES.
CONCLUSIONS: When compared with BMS, PCI with DES was safe and reduced the rate of angiographic restenosis in patients with CAV. A randomized clinical trial comparing BMS versus DES with longer follow-up is needed to identify the optimal long-term revascularization strategy in patients with CAV.
Authors:
Michael S Lee; Jon Kobashigawa; Jonathan Tobis
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  1     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-11     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  710-5     Citation Subset:  IM    
Affiliation:
Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. mslee@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation*
Coronary Angiography
Coronary Stenosis / etiology,  mortality,  radiography,  therapy*
Drug-Eluting Stents*
Female
Graft Occlusion, Vascular / etiology,  mortality,  radiography,  therapy*
Graft Survival
Heart Transplantation / adverse effects*,  mortality
Humans
Los Angeles
Male
Metals*
Prosthesis Design
Retrospective Studies
Severity of Illness Index
Stents*
Thrombosis / etiology,  prevention & control
Time Factors
Transplantation, Homologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Metals
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2009 May;2(5):474; author reply 474-5   [PMID:  19463475 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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