Although several studies have previously reported on the efficacy of percutaneous
coronary intervention (PCI) with first-generation drug-eluting stents (DES) in heart
transplant patients with cardiac allograft vasculopathy, few data regarding new-generation
DES are currently available. We sought to compare the efficacy of new-generation versus
first-generation DES in 90 consecutive patients with heart transplant (113 de novo
coronary lesions) who underwent urgent or elective PCI with first-generation (28 patients)
or new-generation (62 patients) DES. For each patient, the severity of cardiac allograft
vasculopathy and postprocedural extent of revascularization were quantified calculating
baseline and residual SYNTAX score, respectively. The primary end point was a composite
of major adverse cardiac events—myocardial infarction, cardiovascular death, or target
vessel revascularization—at 3 years. Overall, the median baseline SYNTAX score was
8 (5 to 15), and a total number of stents per patient of 1.6 ± 0.9 was implanted.
Post-PCI residual SYNTAX score was 1.5 (0 to 4), with 13 patients having a score >8.
At 3 years, the Kaplan–Meier estimate of freedom from major adverse cardiac events
was 64%, with no differences between first-generation and new-generation DES groups
(log-rank test p = 0.269). Nevertheless, patients treated with new-generation DES
experienced a lower rate of target vessel revascularization (15% vs 31%, log-rank
test p = 0.058). In the multivariate Cox regression analysis, a post-PCI residual
SYNTAX score >8 (hazard ratio 2.37, confidence interval 0.98 to 5.73, p = 0.054) was
identified as an independent predictor of the primary end point.
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Article info
Publication history
Published online: November 26, 2022
Received in revised form:
October 11,
2022
Received:
June 27,
2022
Footnotes
Funding: None.
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