Document Detail

In-stent restenosis and remote coronary lesion progression are coupled in cardiac transplant vasculopathy but not in native coronary artery disease.
MedLine Citation:
PMID:  16875968     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to describe the clinical, angiographic, and histological features of concomitant in-stent restenosis (ISR) and cardiac allograft vasculopathy (CAV) progression. BACKGROUND: Cardiac allograft vasculopathy is a major challenge to long-term success of heart transplantation. Coronary stenting for CAV is hampered by ISR. METHODS: Quantitative coronary angiography compared late lumen loss (LL) at stented and reference, non-stented segments during 1-year follow-up in post-heart transplant and control atherosclerosis patients. Stented and non-stented arteries with CAV were also obtained post-mortem for immunohistochemical analysis. RESULTS: In 37 stented lesions (25 patients), 1-year binary restenosis occurred in 37.8%. Patients with ISR had higher long-term cardiac death/myocardial infarction rates than patients without ISR (53.8% vs. 9.1%, p = 0.03). In the same 25 patients, 34 CAV lesions with non-significant obstructions were identified as reference controls. After 1 year, patients who developed ISR also had more control lesion LL (0.78 +/- 0.38 mm vs. 0.39 +/- 0.27 mm, p < 0.006) compared to patients without ISR. In the post-transplant patients, in-stent LL was closely coupled to control segment LL (R(2) = 0.63, p < 0.05). Conversely, in native atherosclerosis patients, ISR and remote disease progression were not correlated. Histological staining of stented and control arteries from CAV patients revealed similar pathologies common to ISR and non-intervened CAV segments. CONCLUSIONS: Progression of CAV at non-intervened segments and ISR correlate strongly and share common histopathology. Optimized treatment for patients with aggressive CAV needs to address the widespread nature of this disease, even when it presents as an initially focal lesion.
Michael Jonas; James C Fang; John C Wang; Satyendra Giri; Dan Elian; Yedael Har-Zahav; Hung Ly; Philip A Seifert; Jeffrey J Popma; Campbell Rogers
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2006-07-12
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2006-08-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  453-61     Citation Subset:  AIM; IM    
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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MeSH Terms
Cardiovascular Diseases / mortality
Case-Control Studies
Coronary Angiography*
Coronary Artery Disease / therapy
Coronary Disease / diagnosis*,  etiology,  mortality,  therapy*
Coronary Restenosis / diagnosis*
Coronary Vessels / pathology
Disease Progression
Heart Transplantation / adverse effects*
Middle Aged
Myocardial Infarction / epidemiology
Transplantation, Homologous
Comment In:
J Am Coll Cardiol. 2006 Aug 1;48(3):462-3   [PMID:  16875969 ]

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