Background:
Although cardiac allograft vasculopathy (CAV) represents a common complication in heart transplantation (HTX) recipients, data investigating predictors of prognosis in patients with CAV are limited. The study sought to investigate the prognostic impact left ventricular ejection fraction (LVEF) undergoing percutaneous coronary intervention (PCI) in HTX recipients.
Methods:
Patients with HTX who underwent PCI between January 2011 and June 2023 were included retrospectively at one center. Baseline characteristics, as well as lesion and interventional characteristics were compared between patients with LVEF > 50% and ≤ 50%, further risk stratification was performed comparing patients with LVEF ≥ 50, 41-49 and ≤ 40% and LVEF as continuous variable (per % increase). The primary endpoint was all-cause mortality at 3 years, the key secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE).
Results:
One hundred fifty-nine HTX recipients undergoing PCI were included with a median LVEF of 55.45% (i.e., LVEF >50%: 67%; LVEF ≤ 50%: 33%). Patients with a reduced LVEF were younger (mean 54.13 vs. 59.34 years, p = 0.045) and had a higher BMI prior to Intervention (mean 28.10 vs. 26.19 kg/m², p = 0.012) and presents with a higher ISHLT class (p < 0.001). In the adjusted analysis, a reduced LVEF was associated with a lower rate of technical success (OR = 0.350; 95% CI 0.124 –0.991; p = 0.048), as well as adversely impacted procedural success (OR = 0.334; 95% CI 0.120 – 0.928; p = 0.035). Patients with a LVEF ≤50% had a higher risk of all-cause mortality at 3 years (42.31% vs. 19.63%, p = 0.003), which was still evident after multivariable adjustment (adjusted hazard ratio (HR)=2.684; 95% CI 1.395 – 5.167; p = 0.003). In line, the risk of MACCE at 3 years was higher in patients with reduced LVEF (adjusted HR=1.803; 95%CI 1.055 - 3.079; p = 0.031).
Conclusion:
In patients undergoing PCI after HTX, a reduced LVEF was an independent predictor of lower technical and procedural success, and was independently associated with impaired long-term prognosis.
