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07 April 2020 : Original article  

Everolimus-Eluting Second-Generation Stents for Treatment of De Novo Lesions in Patients with Cardiac Allograft Vasculopathy

Łukasz Pyka1ABDE*, Michał Hawranek1ADE, Bożena Szyguła-Jurkiewicz1EFG, Piotr Desperak1BC, Wioletta Szczurek1BF, Andrzej Lekston1EG, Mariusz Gąsior1AEG, Michał O. Zembala2BF, Szymon Pawlak2F, Marian Zembala2FG, Piotr Przybyłowski34AE

DOI: 10.12659/AOT.921266

Ann Transplant 2020; 25:e921266

Abstract

BACKGROUND: Cardiac allograft vasculopathy is a major cause of cardiac allograft rejection. Percutaneous coronary intervention has become the main form of treatment of significant focal lesions. Despite the significance of the problem, data remain scarce. With a large population of transplant recipients undergoing coronary angiography at our center, we decided to analyze the implications of the use of everolimus-eluting second-generation stents by performing 6-month clinical and angiographic follow-up.

MATERIAL AND METHODS: From December 2012 and August 2019, 319 patients after heart transplantation undergoing coronary angiography at our institution were analyzed. Subsequently, 22 patients underwent de novo angioplasty with second-generation everolimus-eluting stents. The primary study endpoint was angiographic restenosis as evaluated by quantitative coronary angiography. Secondary outcomes included binary restenosis, target lesion revascularization, and cardiac death during the follow-up period (6 months).

RESULTS: Patient comorbidities included hypertension (77.3%), type 2 diabetes mellitus (68.2%), dyslipidemia (68.2%), and obesity (31.8%). Primary success was obtained in all of the treated lesions. The analysis of quantitative coronary angiography after 6-month follow-up revealed low late lumen loss (0.22±0.40). Significant restenosis was observed in 1 of the cases. There were no deaths in the 6-month observation period.

CONCLUSIONS: In the analyzed population, invasive strategy with second-generation everolimus-eluting stents for de novo lesions in cardiac allograft vasculopathy resulted in a low rate of binary restenosis, low late lumen loss, and no deaths during the 6-month follow-up.

Keywords: Coronary Artery Disease, drug-eluting stents, Transplantation Tolerance, Aged, Cohort Studies, Coronary Angiography, Everolimus, Female, Heart Transplantation, Humans, Immunosuppressive Agents, Male, Middle Aged, percutaneous coronary intervention, Postoperative Complications, Treatment Outcome

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358