Log in to MyACC
Donor-Transmitted CAD in Heart Transplant Recipients
Quick Takes
- Significant donor-transmitted coronary artery disease (TCAD) is an independent risk factor for cardiovascular mortality and MACE but not overall survival.
- Nonsignificant TCAD was not associated with reduced survival in patients alive and well enough to undergo post-HT angiography within the first 3 months.
- There is a need for additional investigation to define the optimum management strategies for prevention of ischemic events in recipients of transplanted hearts with CAD.
Study Questions:
What is the prevalence of donor-transmitted coronary artery disease (TCAD) by coronary angiography (c-angio) performed after heart transplant (HT) and its prognostic relevance?
Methods:
The investigators conducted a retrospective study of consecutive patients aged >18 years who underwent HT in 11 Spanish centers from 2008–2018. Only patients with a c-angio within the first 3 months post-HT were studied. Significant TCAD (s-TCAD) was defined as any stenosis ≥50% in epicardial coronary arteries, and nonsignificant TCAD (ns-TCAD) as stenosis <50%. Patients were followed over a median period of 6.3 years after c-angio. Clinical outcomes were assessed by means of Cox regression and competing risks regression.
Results:
From a cohort of 1,918 patients, 937 underwent c-angio. TCAD was found in 172 patients (18.3%): s-TCAD in 65 (6.9%) and ns-TCAD in 107 (11.4%). Multivariable Cox regression did not show a statistically significant association between s-TCAD and all-cause mortality (adjusted hazard ratio [aHR], 1.44; 95% confidence interval [CI], 0.89–2.35; p = 0.141); however, it was an independent predictor of cardiovascular (CV) mortality (aHR, 2.25; 95% CI, 1.20–4.19; p = 0.011) and the combined event CV death or nonfatal major adverse cardiovascular events (MACE) (aHR, 2.42; 95% CI, 1.52–3.85; p < 0.001). No statistically significant impact of ns-TCAD on clinical outcomes was detected. Results were similar when re-assessed by means of competing risks regression.
Conclusions:
The authors report that TCAD was not associated with reduced survival in patients alive and well enough to undergo post-HT angiography within the first 3 months, but s-TCAD patients showed increased risk of CV death and MACE.
Perspective:
This study assessed a contemporary cohort of patients who underwent HT within the Spanish transplant network and identified s-TCAD as an independent risk factor for CV mortality and MACE but not overall survival. Of note, ns-TCAD was not associated with reduced survival in patients alive and well enough to undergo post-HT angiography within the first 3 months. These data suggest the need for additional investigation to define the optimum management strategies for prevention of ischemic events in recipients of transplanted hearts with CAD, especially in countries with low numbers of optimal donors.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Cardiac Surgical Procedures, Coronary Angiography, Coronary Artery Disease, Heart Failure, Heart Transplantation, Myocardial Ischemia, Risk Factors, Secondary Prevention, Survival, Transplant Recipients
< Back to Listings
