Document Detail

Outcomes of bare metal versus drug-eluting stents in allograft vasculopathy.
MedLine Citation:
PMID:  18971095     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because of improved outcomes with drug-eluting stents (DES), we examined angiographic and clinical outcomes of bare metal stents (BMS) vs DES for discrete lesions in chronic allograft vasculopathy. METHODS: Heart transplant patients who underwent percutaneous coronary intervention were divided into one of two groups: BMS or DES. Baseline clinical characteristics, rejection episodes and procedural details were compared. Distal arteriopathy was qualitatively compared using the Gao score. End-points included angiographic in-stent restenosis, acute coronary syndrome (ACS), ST-elevation myocardial infarction, heart failure admissions and cardiac death at 1 year. Student's t-test, chi-square test and the Mann-Whitney U-test were utilized to assess the results. Correlations were assessed using Pearson's correlation coefficient. RESULTS: Forty-two patients with 80 stents (56 DES, 24 BMS) were identified. Baseline clinical characteristics, immunosuppression regimen, cardiac risk factors, frequency of rejection and procedural details were similar. Distal arteriopathy was similar (p = 0.374), suggesting equally advanced vasculopathy. Twenty-nine patients (69%) and 46 lesions (58%) were available at 1 year for clinical and angiographic follow-up. One-year diameter stenosis (26.1 +/- 21.3% vs 31.7 +/- 38.3%; p = 0.602) and binary restenosis (22.6% vs 22.7%; p = 0.774) rates were similar for DES and BMS, respectively. There were no ST-elevation infarctions; ACS [9 (16%) vs 5 (21%) p = 0.638] and cardiac death (2 in both groups) were similar for DES and BMS, respectively. Heart failure admissions were more frequent in the DES group [18 (32%) vs 5 (21%); p = 0.016]. No clinical predictors were identified. CONCLUSIONS: In-stent stenosis, ACS and cardiac death at 1 year were similar for DES and BMS. The milieu of systemic immunosuppression in heart transplant decreases the advantages of DES in allograft vasculopathy.
Proddutur R Reddy; Akhil Gulati; Lowell Steen; James Sinacore; Ferdinand Leya; Alain Heroux
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  27     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-02-13     Revised Date:  2009-05-06    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1222-8     Citation Subset:  IM    
Division of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Restenosis / epidemiology*,  mortality
Drug-Eluting Stents*
Equipment Design
Heart Catheterization
Heart Failure / epidemiology
Heart Transplantation / adverse effects*
Postoperative Complications / surgery
Transplantation, Homologous
Treatment Outcome
Comment In:
J Heart Lung Transplant. 2009 May;28(5):531   [PMID:  19416788 ]

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

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