La malattia coronarica del cuore trapiantato: prevalenza, aspetti angiografici ed eziopatogenetici.

Progressive coronary artery disease is the most important factor influencing late mortality after heart transplantation. The aim of the study was to evaluate prevalence and clinical and angiographic findings of accelerated atherosclerosis in cardiac transplanted patients. During the first 5 years of the Heart Transplant Clinical Program at Policlinico S Matteo, Pavia, 81 patients underwent 156 coronary angiographies. The immunosuppressive therapy was based on cyclosporine, azathioprine and steroids; in some patients a reduced immunosuppressive schedule was started because of the presence of adverse effects. Coronary angiographies were performed in 68 patients after 1 year, in 40 patients after 2 years, in 19 patients after 3 years and in 18 patients after 4 years. The presence of coronary artery disease was defined by the angiographic occurrence of any decrease in the luminal diameter (including minor irregularities): according to these criteria coronary artery disease was found in 29 angiographies, performed in 13 patients, with a prevalence of 16% (13/81). An evaluation of the annual incidence showed respectively 14.7% at 1 year, 22.5% at 2 years, 31.5% at 3 years, 22.2% at 4 years. Coronary artery disease involvement was predominantly monovascular (56%) after 1 year and with a multivessel expression in the following years (2-vessel disease 33%, 3-vessel disease 50%). The major clinical problems in the transplanted patients with coronary artery disease were 3 deaths, related with heart failure in 2 cases and with sudden death in 1 case, and a new transplantation procedure in 2 patients. Prevalence and incidence of coronary artery disease observed after heart transplantation in this population were similar to those reported by other Authors.(ABSTRACT TRUNCATED AT 250 WORDS)