Long-Term Mortality After Cardiac Allograft Vasculopathy Implications of Percutaneous Intervention
Long-Term Mortality After Cardiac Allograft Vasculopathy Implications of Percutaneous Intervention
复制标题
DOI：
10.1016/j.jchf.2014.01.003
复制
发表时间：
2014-06-01
影响因子：
13
通讯作者：
Oliveira, Guilherme H.
中科院分区：
文献类型：
--
作者：
Agarwal, Shikhar;Parashar, Akhil;Oliveira, Guilherme H.
目的比较经皮介入治疗（PCI）的近端心脏移植物血管病变（CAV）患者与不能接受PCI治疗的严重CAV患者的预后。PCI已被用于治疗局灶性CAV患者，但其疗效尚不清楚。方法853例接受OHT和随后的冠状动脉造影在克利夫兰诊所，所有患者至少中度CAV（>30%）的任何冠状动脉造影OHT后。在其余无/轻度CAV的患者中，随机选择200例患者作为对照组。结果393例患者中，100例接受了明确的CAV介入治疗。在这100例患者中，90例患者仅接受PCI，6例患者接受冠状动脉旁路移植术，4例患者接受重复OHT。我们观察到随着CAV恶化，长期死亡率逐渐增加。与其他组相比，ISHLT 3级CAV患者的长期死亡率最高。此外，2年随访时死亡风险显著降低（校正比值比：0.26; 95%置信区间[CI]：0.08 - 0.82）和5年随访（调整的比值比：0.28; 95% CI：0.09至0.93）与诊断为ISHLT 3级CAV的患者相比，后者被认为不适合PCI。此外，他汀类药物的使用与显着的生存益处与CAV患者（风险比：0.21; 95%CI：0.07至0.61）。结论恶化的严重程度，CAV与心脏移植受者的长期生存进行性恶化。在CAV患者中，适合PCI治疗的CAV患者的长期生存率高于不能接受PCI治疗的重度CAV患者。(C)2014年美国心脏病学会基金会
Objectives This study compared the prognosis of patients with proximal cardiac allograft vasculopathy (CAV) treated with percutaneous intervention (PCI) to the prognosis of those with severe CAV not amenable to PCI.Background CAV is a progressive form of arterial narrowing affecting patients with orthotopic heart transplants (OHTs). PCI has been used to treat patients with focal CAV, but its efficacy remains unclear.Methods Of 853 patients undergoing OHT and subsequent coronary angiographies at the Cleveland Clinic, all patients with at least moderate CAV (>30%) on any coronary angiogram following OHT were included. Of remaining patients with no/mild CAV, 200 patients were randomly chosen to represent the comparison group. All angiograms of the included patients were reviewed and graded according to the International Society of Heart and Lung Transplantation (ISHLT) nomenclature.Results Of the 393 included patients, 100 patients underwent definitive intervention for CAV. Of these 100 patients, 90 patients underwent PCI only, 6 patients underwent coronary artery bypass grafting, and 4 patients underwent repeat OHT. We observed a progressive increase in long-term mortality with worsening CAV. Patients with ISHLT grade 3 CAV had the highest long-term mortality compared with other groups. In addition, there was a significant reduction in the risk for mortality at 2-year follow-up (adjusted odds ratio: 0.26; 95% confidence interval [CI]: 0.08 to 0.82) and 5-year follow-up (adjusted odds ratio: 0.28; 95% CI: 0.09 to 0.93) after PCI compared with patients diagnosed with ISHLT grade 3 CAV, who were deemed unsuitable for PCI. Furthermore, statin use was associated with a significant survival benefit in patients with CAV (hazard ratio: 0.21; 95% CI: 0.07 to 0.61).Conclusions Worsening severity of CAV was associated with progressively worse long-term survival among heart transplant recipients. Among patients with CAV, long-term survival in those with CAV amenable to PCI was greater than that in those with severe CAV not treatable with PCI. (C) 2014 by the American College of Cardiology Foundation