Premium
Long‐term clinical and angiographic outcomes of percutanenous coronary intervention with everolimus‐eluting stents for the treatment of cardiac allograft vasculopathy
Author(s) -
Cheng Richard,
Vanichsarn Christopher,
Patel Jignesh K.,
Currier Jesse,
Chang David H.,
Kittleson Michelle M.,
Makkar Raj,
Kobashigawa Jon A.,
Azarbal Babak
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26830
Subject(s) - medicine , conventional pci , restenosis , mace , percutaneous coronary intervention , cardiology , stent , revascularization , coronary artery disease , stenosis , myocardial infarction
Background Percutaneous coronary intervention (PCI) with bare‐metal and first‐generation drug‐eluting stents (DES) for cardiac allograft vasculopathy (CAV) is associated with unexpectedly high restenosis rates and target lesion revascularization (TLR). Long‐term outcomes of stenting for CAV using second‐generation everolimus‐eluting stents (EES) are not established. Objective To evaluate clinical and angiographic outcomes of CAV stenting with EES. Methods Patients who underwent PCI with EES for CAV were studied. Surveillance angiography was performed at 6–12 months post‐PCI and as indicated. Patient survival, freedom from MACE, binary restenosis, TLR, target vessel revascularization (TVR), and non‐TVR are reported. Results One‐hundred and thirty two EES were placed in 113 discrete lesions in 48 patients. Pre‐PCI stenosis was 82.1 ± 12.4%, and average stent length and diameter were 16.9 ± 5.7 and 3.0 ± 0.6 mm, respectively. Mean follow‐up was 30.7 ± 18.8 months. Time from transplantation to PCI was 9.9 ± 5.1 years. Post‐PCI survival at 1 (93.5 ± 3.6%), 2 (91.0 ± 4.3%), and 3 years (83.8 ± 6.3%), and freedom from MACE (87.2 ± 4.9%, 82.3 ± 5.7%, 75.8 ± 6.9%) were high. Binary restenosis at 1 (3.0 ± 1.7%), 2 (6.9 ± 3.2%), and 3 years (10.0 ± 4.3%) mirrored expected rates with EES use in native CAD. One‐, two‐, and three‐year rates of TLR (5.1 ± 2.5%, 14.3 ± 4.6%, and 21.2 ± 6.3%), TVR (17.1 ± 4.5%, 39.0 ± 6.9%, and 46.2 ± 7.8%), and NTVR (26.3 ± 5.4%, 55.4 ± 7.0%, and 58.0 ± 7.0%) remain high. Diabetes was associated with an increased hazard ratio for binary restenosis 6.084 (95% CI 1.271–29.133, P = 0.024). Conclusions PCI strategy using EES in the treatment of CAV was associated with a low binary restenosis rate, a high survival rate, and a high rate of freedom from MACE. However, at 3 years, TLR and TVR rates appeared similar to rates observed with first‐generation DES. © 2016 Wiley Periodicals, Inc.