The following is the summary of “First- Versus New-Generation Drug-Eluting Stents in Patients With Heart Transplant With Cardiac Allograft Vasculopathy” published in the 1 February 2023 issue of Cardiovascular Disease by Munafò, et al.
In several studies, percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) has been shown to be effective in treating cardiac allograft vasculopathy in heart transplant patients. However, there is cently needs to be more data about new-generation DES. In this study, researchers compared the efficacy of first-generation DES (28 patients) and new-generation DES (62 patients) in urgent or elective PCI in heart transplant patients (113 de novo coronary lesions).
Baseline and residual SYNTAX scores were calculated for each patient to assess the degree of cardiac allograft vasculopathy before and after the procedure. Myocardial infarction, cardiovascular mortality, and revascularization of the target vessel all occurred within 3 years and were considered the primary endpoint. Patients had a mean of 1.6±0.9 stents placed, with a median baseline SYNTAX score of 8 (range: 5–15). The mean SYNTAX score after PCI was a 0–4 residual score, while 13 patients scored 8 or higher. The Kaplan-Meier survival estimate free of major adverse cardiac events at 3 years was 64% in the older and newer DES groups (log-rank test P=0.269).
Still, those who were given newer DES had a reduced rate of target vessel revascularization (15% vs. 31%, log-rank test P=0.058). In addition, a post-PCI residual SYNTAX score of more than 8 was found to be an independent predictor of the primary endpoint in a multivariate Cox regression analysis (hazard ratio 2.37, confidence range 0.98 to 5.73, P=0.054).