TCT CONNECT-247 Outcomes of Percutaneous Coronary Intervention in Cardiac Transplant Patients: A Bi-national Analysis Derived From the United Kingdom and United States

Nagaraja, Vinayak; Rashid, Muhammad; Anderson, H.; Ludman, Peter; Kapadia, Samir; Starling, Randall; Alraies, M. Chadi; Kwok, Shing; Mohamed; Curzen, Nick; Mamas, Mamas

Abstract

Background
Five years after transplantation, coronary allograft vasculopathy and late graft failure account for 32% of all mortality. The current role of percutaneous coronary intervention (PCI) in coronary allograft vasculopathy is unclear and considered palliative, although some studies have reported improved survival in coronary allograft vasculopathy treated by PCI. This study compared and contrasted the indications, clinical and procedural characteristics, and outcomes of patients with an orthotopic heart transplant undergoing PCI in the United Kingdom and the United States compared with those of patients without cardiac transplantation.

Methods
The BCIS (British Cardiovascular Intervention Society) registry (2007 to 2014) and the U.S. NIS (National Inpatient Sample) (2004 to 2014) data were utilized for this analysis.

Results
There were 466 PCI procedures (0.09%) and 1,122 (0.02%) performed in cardiac transplant patients in the BCIS and NIS registries, respectively. The cardiac transplant PCI cohort, compared with a non–cardiac transplant PCI cohort, was younger; included mostly men; with an increased prevalence of chronic kidney disease, left main PCI, and multivessel disease; and lower use of newer antiplatelets agents, antithrombotics, and radial artery access. In the BCIS registry, the cardiac transplant PCI cohort had similar in-hospital mortality (odds ratio [OR]: 1.05; p = 0.91), 30-day mortality (OR: 1.38; p = 0.31), vascular complications (OR: 0.69; p = 0.46), and major adverse cardiac events (OR: 1.41; p = 0.26) as the non–cardiac transplant PCI cohort did. However, the cardiac transplant group had higher 1-year mortality (OR: 2.30; p < 0.0001). The NIS data analysis revealed similar rates of in-hospital mortality (OR: 2.40; p = 0.14), cardiac complications (OR: 0.26; p = 0.17), major bleeding (OR: 0.36; p = 0.16), vascular complications (OR: 0.46; p = 0.45), and stroke (OR: 0.50; p = 0.40) in the cardiac transplant PCI cohort as in non–cardiac transplant PCI cohort.

Conclusion
PCI in cardiac transplant recipients was associated with similar short-term mortality and vascular complications compared with PCI in the general populace. However, a higher 1-year morality was observed in the BCIS cohort.

Citation

Nagaraja, V., Rashid, M., Anderson, H., Ludman, P., Kapadia, S., Starling, R., …Mamas, M. (2020). TCT CONNECT-247 Outcomes of Percutaneous Coronary Intervention in Cardiac Transplant Patients: A Bi-national Analysis Derived From the United Kingdom and United States. Journal of the American College of Cardiology, 76(17), B109. https://doi.org/10.1016/j.jacc.2020.09.264

• Journal Article Type: Article
• Conference Name: 32nd Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT); October 14-18, 2020
• Conference Location: Cardiovascular Research Foundation, New York, USA
• Online Publication Date: Oct 22, 2020
• Publication Date: 2020-10
• Deposit Date: Jun 26, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 76
• Issue: 17
• Pages: B109
• DOI: https://doi.org/10.1016/j.jacc.2020.09.264
• Keywords: Cardiology and Cardiovascular Medicine
• Additional Information: This article is maintained by: Elsevier; Article Title: TCT CONNECT-247 Outcomes of Percutaneous Coronary Intervention in Cardiac Transplant Patients: A Bi-national Analysis Derived From the United Kingdom and United States; Journal Title: Journal of the American College of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jacc.2020.09.264; Content Type: simple-article; Copyright: Copyright © 2020 Published by Elsevier Inc.