Outcomes of percutaneous coronary intervention of chronic total occlusions in heart transplant recipients

Abstract

ABSTRACT Introduction and objectives: Chronic total coronary occlusion (CTO) of coronary arteries is frequent in heart transplant recipients (HTR). It is usually managed with medical therapy due to the suboptimal results shown by the percutaneous coronary intervention (PCI). Although the PCI of native CTOs is performed in experienced centres, in HTR we do not know PCI results or clinical efficacy. This is the first study ever to actually analyse the PCI-Target Lesion Procedure Success of CTO PCI and its angiographic and clinical follow-up in HTR. In addition, we compared the clinical follow-up of CTO vs non-CTO PCI in HTR. Methods: We retrospectively analysed the baseline characteristics, procedural outcomes and clinical events during the follow-up of HTR with CTO undergoing PCI between January 1, 2006 and December 31, 2016 in 2 centres with an ongoing CTO program. Over the same period, we also compared clinical events during the follow-up of these patients vs PCI on non-CTO stenosis in HTR at one of the centres. Results: PCI was successful in 13 out of 14 patients. A systematic follow-up angiography was conducted at centre 1 (n = 10). Two patients showed in-stent restenosis (20%), and a new PCI was performed successfully in both cases. Mortality rate was 28.5%, after a median follow-up of 33.5 months [interquartile range, 20-50]. We found no statistical differences in the clinical events after the PCI of CTO lesions vs non-CTO lesions in HTR. Conclusions: The PCI of CTO in HTR is feasible in experienced centres and selected patients, with a high success rate and low rate of intraprocedural complications.

Keywords

• Chronic total coronary occlusion
• Heart transplantation
• Coronary angioplasty
• Cardiac allograft vasculopathy
• Results