(554) Revascularization of Donor Transmitted Coronary Artery Disease After Heart Transplantation: Impact on Survival and Cardiovascular Events. Insights from the DONOR-CAD Study

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S250 - S251
• Main Authors: Couto-Mallon, D., Bonet, L. Almenar, Barge-Caballero, E., Lozano-Jiménez, S., García, J. López-Azor, Gardeta, T. Domingo, Castel, M.A., Perez, S. Mirabet, Bravo, I. Garrido, Diez-Lopez, C., Granados, A. López, Anton, R. Manrique, Muñiz, J., Crespo-Leiro, M.G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.569

The best treatment for patients with donor transmitted coronary artery disease (TCAD) after heart transplantation (HT) is unknown. Our purpose was to assess if revascularization of TCAD improves survival or cardiovascular (CV) adverse events after HT.
Retrospective study of HT patients > 18-year-old between 2008-2018 in 11 centers from Spain. Only patients with a coronary angiogram (c-angio) performed within the first 3 months after HT were analyzed. Angiographically significant coronary artery disease (s-TCAD) was defined as stenosis ≥ 50% in epicardial coronary arteries. Non-significant coronary artery disease (ns-TCAD) was defined as stenosis < 50%. The indication for revascularization was according to the clinical decision of each center. Differences in overall mortality, CV mortality and CV adverse events between revascularized (R) and non-revascularized (NR) patients were compared using Chi-square and Fisher's test when indicated.
From cohort of 1918 patients, 937 underwent c-angio. s-TCAD was found in 65 patients (6.9%) and ns-TCAD in 107 (11.4%). Among s-TCAD patients, 24 (37%) underwent revascularization at a median time of 42 days (interquartile range 20-65 days) by percutaneous coronary intervention. 36 patients were tested for ischemia by stress or exercise echocardiography and 5 were not revascularized or tested for ischemia. No one of the ischemia tests were positive. After a median of 6.3 years of follow-up, there were not found significant differences in all-cause mortality between R and NR patients (25 vs 29.3%, p=0.780). CV mortality (12.5 vs. 12.2%) and combined CV adverse event (20.8 vs 19.5%) were also similar (table).
In our study about 35% of patients with s-TCAD underwent percutaneous revascularization and this approach was no better than medical treatment in terms of survival and/or CV adverse events.