Influence of left ventricular ejection fraction on the clinical outcome of percutaneous coronary interventions in heart transplant patients - Scorecard - MDSpire
Clinical Scorecard: Impact of Left Ventricular Ejection Fraction on Outcomes Following Percutaneous Coronary Interventions in Heart Transplant Recipients
At a Glance
Category
Detail
Condition
Cardiac allograft vasculopathy (CAV) and outcomes after PCI in adult heart transplant recipients
Key Mechanisms
The introduction describes CAV progression as involving endothelial dysfunction and inflammation, resulting in concentric intimal expansion, proliferation, fibrosis, and vascular remodeling. With advancing disease, these processes may reduce coronary blood flow and impair myocardial function.
Target Population
Adults who received a heart transplant and underwent PCI after transplantation; patients were stratified by pre-intervention LVEF > 50% or ≤ 50%.
Care Setting
Retrospective, single-center analysis of PCI performed in routine clinical practice for stable CAV or acute coronary syndrome, with follow-up for up to three years.
Key Highlights
The study included 159 heart transplant recipients who underwent PCI between January 2011 and June 2023.
Before PCI, 107 patients (67.3%) had LVEF > 50% and 52 (32.7%) had LVEF ≤ 50%.
The primary endpoint was all-cause mortality during follow-up of up to three years.
Secondary endpoints included mortality and MACCE during the index hospitalization and at three months, one year, and three years.
The supplied article excerpt does not include outcome estimates or comparisons between LVEF groups.
Guideline-Based Recommendations
Diagnosis
Study definition: CAV was defined according to the 2010 International Society for Heart and Lung Transplantation consensus statement.
Study method: Pre-intervention LVEF was the most recent measurement before PCI, assessed using the biplane Simpson’s method.
Management
In routine clinical practice, the treating physician determined whether to perform PCI.
The introduction lists medication adjustment, PCI, bypass graft surgery, and retransplantation as available CAV treatments; it notes retransplantation is rarely feasible because of limited donor availability.
Monitoring & Follow-up
The study assessed all-cause mortality and MACCE through a maximum of three years after the initial PCI.
Follow-up information was obtained from ambulatory visits, hospital readmissions, and documented findings from other hospitals.
Risks
Study endpoint definition: MACCE comprised all-cause mortality, myocardial infarction, stroke, or target vessel or target lesion revascularization by PCI or CABG.
Patient & Prescribing Data
The cohort comprised 159 adults with a history of heart transplantation who underwent PCI; 52 had pre-procedural LVEF ≤ 50% and 107 had LVEF > 50%.
PCI was performed for stable CAV or acute coronary syndrome, with the decision made by the treating physician. The excerpt provides no medication regimens or comparative treatment-effect estimates.
Clinical Best Practices
For study classification, reduced LVEF was defined as ≤ 50% and preserved LVEF as > 50%.
Technical PCI success was defined as residual stenosis < 30% with TIMI flow grade 3.
Procedural success required technical success without in-hospital MACCE.
Each patient was included once, based on their first PCI during the study period.
The proposed framework classified 30% of patients as high or extreme risk, compared with 12% classified as having severe or greater tricuspid regurgitation under established grading schemes.
