Lesion-Characteristics and Interventional Success after CTO-PCI in post HTX patients

Background: A few up-to-date studies have investigated the characteristics and procedural success of chronic total occlusions (CTO) in coronary artery disease (CAD). However, there is no study investigating these in cardiac allograft vasculopathy (CAV) – a leading cause of late graft dysfunction. We aim to determine the characteristics of the CTOs and how successful CTO-PCI was - additionally investigating the long-term outcome regarding major adverse cardiac and cerebrovascular events (MACCE) and Mortality.

Methods: Patients who underwent PCI after HTX between January 2011 and June 2023 were identified and transferred into a database for analysis. They were analyzed regarding baseline characteristics, vessel-, and interventional characteristics, MACCE in the follow-up period up to three years as well as long-term survival and compared to a control population without HTX. Results: Lesion-, and interventional characteristics are shown in the graphs below. There were no differences in the occurrence of in-hospital MACCE (4.35% HTX vs. 1.97% Control, p = 0.236), while after that MACCE occurred more often in patients with HTX over time (p < 0.001). The overall risk of mortality in the HTX group was higher compared to the control (30,43% HTX vs. 5,88% Control, p < 0.001). Multivariate analysis showed that transplant status (HR = 4.171; 95%CI = 2.678 – 6.494; p = 0.001) increased the risk of MACCE. Furthermore, the transplant status was associated with an increased risk of all-cause mortality (HR = 5.039; 95%CI = 2.558 – 9.925; p = 0.001).

Conclusion: Patients after HTX present with different lesion characteristics and have a lower success rate in CTO-PCI. The graft status itself is a major risk factor for the occurrence of MACCE and overall mortality at three-year follow-up.