The goal of this study is to assess whether or not the new donor heart allocation method in the United States reduces the risk of early cardiac allograft vasculopathy (CAV). Cohort research that looks backward in time. Patients aged more than 18 years and up who received heart transplants between October 18, 2015, and October 17, 2018 (previous system) and October 18, 2018, and May 31, 2020 (current system) and who are registered in the United Network for Organ Sharing database (new system). CAV on angiography at 1 year (accelerated CAV) in the general transplant population and the highest acuity subset, including those with a Status 1A (old) or 2 graft function (new). To determine risk variables for CAV acceleration, researchers used multivariate logistic regression models incorporating demographic, cardiovascular, and transplant characteristics for both the recipient and the donor. There were a total of 10,375 transplant recipients, with 6,660 (or 64%) included in the previous allocation group and 3,715 (or 36%) included in the new allocation cohort. There were 521 cases of accelerated CAV during the old time period (8%), but only 272 cases during the current time period (7%; P=.36). The highest acuity subgroup had an incidence rate of 8% (363 cases), which was similar to the overall rate of 7% (143 cases) (P=.13). The new allocation mechanism was not linked to an increased chance of accelerated CAV in adjusted analyses of the high-acuity cohort (odds ratio=0.87, 95% CI: 0.70-1.08, P=.20). After 1 year, the new donor heart allocation mechanism is not linked to an increase in the incidence of accelerated angiographic CAV, and this holds true even for the most urgent transplant recipients.