eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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4/2020
vol. 16
 
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Coronary artery disease
abstract:
Clinical research

Coronary revascularization after heart transplant – the search for prognostic factors

Bartlomiej Guzik
1
,
Elżbieta Szczepanek
1
,
Łukasz Niewiara
1
,
Marcin Nosal
1
,
Karol Wierzbicki
2
,
Marcin Krzanowski
3
,
Piotr Szolc
1
,
Bogusław Kapelak
2
,
Krzysztof F. Żmudka
1

1.
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College; John Paul II Hospital, Krakow, Poland
2.
Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
3.
Department of Nephrology, Jagiellonian University Medical College, Krakow, Poland
Arch Med Sci 2020; 16 (4): 789–795
Online publish date: 2020/04/18
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Introduction
Survival after heart transplantation (HTX) is extended due to continuous improvement of medical care, allowing enough time for coronary artery vasculopathy to develop. Data on the clinical outcome of cardiac transplantation patients after percutaneous coronary intervention (PCI) are still not extensively explored. The aim of our study was to assess whether heart transplantation itself compromises the outcome in patients undergoing percutaneous coronary intervention and to assess survival rates as well as major cardiovascular complications in heart transplant recipients who had undergone PCI.

Material and methods
Thirty-three heart transplant recipients who had undergone PCI in the years 2005 to 2015 in a single center were matched by age, sex and main risk factors of arteriosclerosis with 33 controls without heart transplant history. Mean age of patients was 54.6 ±11.4 years in the HTX group and 58.8 ±10.8 years in controls. Median time from heart transplant to PCI was 13 years (4.4–22 years). Case and control groups did not differ in terms of standard risk factors of coronary artery disease, apart from chronic kidney disease, which was present in 70% of patients after heart transplantation, and dyslipidemia, which was present in 91% of control subjects.

Results
Patients after HTX had worse survival compared to controls (p = 0.04). When adjusted for comorbidities in the Cox regression model, there was no significant difference in survival between cardiac transplant recipients and the control group (HR = 1.06; 95% CI: 0.10–11.24). Chronic renal disease was a significant predictor of all-cause mortality (HR = 29.9; 95% CI: 2.3–393). Considering other endpoints, HTX patients had considerably higher incidence of severe bleeding compared to the control group (27% vs. 3%, p < 0.05).

Conclusions
There was no significant difference in myocardial infarction rate, revascularization or hospitalization rates.

keywords:

heart transplantation, percutaneous coronary intervention, survival analysis

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