通过 PCI 减少心脏移植血管病变：定量分析及与心脏移植术后结果的相关性

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2024-10-01 DOI:10.1016/j.cardfail.2024.07.011

MADELEINE ORBAN MD , ANNE KUEHL CandMed , LOUIS PECHMAJOU MD , CHRISTOPH MÜLLER MD , MAROUN SFEIR MD , STEFAN BRUNNER MD , DANIEL BRAUN MD , JOERG HAUSLEITER MD , MARIE-CÉCILE BORIES MD , ANNE-CÉLINE MARTIN MD, PhD , SARAH ULRICH MD , ROBERT DALLA POZZA MD , JULINDA MEHILLI MD , XAVIER JOUVEN MD, PhD , CHRISTIAN HAGL MD , NICOLE KARAM MD, PhD , STEFFEN MASSBERG MD

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引用次数: 0

摘要

背景：经皮冠状动脉介入治疗（PCI）可改善心脏移植（HTx）后患者心脏移植物血管病（CAV）严重阶段的预后。目的：评估国际心肺移植学会（ISHLT）的 CAV 分类在 PCI 后是否仍具有预后意义，以及非移植患者的风险分层模型是否适用于患有 CAV 的 HTx 患者：在欧洲的 2 个学术中心，203 名患者被分为队列 1（ISHLT CAV1，无 PCI，n = 126）或队列 2（ISHLT CAV2 和 3，有 PCI）。在首次诊断 CAV 或首次 PCI 时，分别使用 ISHLT CAV 分级、SYNTAX 评分 I 和 II（SXS-I、SXS-II）来量化基线和残余 CAV（rISHLT、rSXS-I、rSXS-II）。RSXS-I>0定义为不完全血管再通（IR）：结果：SXS-II可预测队列1的死亡率（P = 0.004），而SXS-I（P = 0.009）和SXS-II（P = 0.002）可预测队列2的死亡率。PCI后，IR（P = 0.004）、高rISHLT（P = 0.02）和rSXS-II的最高三分位数（P = 0.006）与较高的5年死亡率相关。在双变量Cox分析中，基线SXS-II、IR和rSXS-II仍然是PCI术后5年死亡率的预测因素。基线和rSXS-I（分别为r = -0.55；P < 0.001和r = -0.50；P = 0.003）与首次再介入间隔时间之间存在很强的反向关系：结论：ISHLT CAV分级者可在PCI术后进行风险分层。SYNTAX评分可作为CAV HTx患者风险分层和有创随访个体化的补充。

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Reduction of Cardiac Allograft Vasculopathy by PCI: Quantification and Correlation With Outcome After Heart Transplantation

Background

Percutaneous coronary intervention (PCI) might improve outcome at severe stages of cardiac allograft vasculopathy (CAV) among patients after heart transplantation (HTx). Yet, risk stratification of HTx patients after PCI remains challenging.

Aims

To assess whether the International Society for Heart and Lung Transplantation (ISHLT) CAV classification remains prognostic after PCI and whether risk-stratification models of non-transplanted patients extend to HTx patients with CAV.

Methods

At 2 European academic centers, 203 patients were stratified in cohort 1 (ISHLT CAV1, without PCI, n = 126) or cohort 2 (ISHLT CAV2 and 3, with PCI). At first diagnosis of CAV or first PCI, respectively, ISHLT CAV grades, SYNTAX scores I and II (SXS-I, SXS-II) were used to quantify baseline and residual CAV (rISHLT, rSXS-I, rSXS-II). RSXS-I > 0 defined incomplete revascularization (IR).

Results

SXS-II predicted mortality in cohort 1 (P = 0.004), whereas SXS-I (P = 0.009) and SXS-II (P = 0.002) predicted mortality in cohort 2. Post-PCI, IR (P = 0.004), high rISHLT (P = 0.02) and highest tertile of rSXS-II (P = 0.006) were associated with higher 5-year mortality. In bivariable Cox analysis, baseline SXS-II, IR and rSXS-II remained predictors of 5-year mortality post-PCI. There was a strong inverse relationship between baseline and rSXS-I (r = -0.55; P < 0.001 and r = -0.50; P = 0.003, respectively) regarding the interval to first reintervention.

Conclusion

People with ISHLT CAV classification could apply for risk stratification after PCI. SYNTAX scores could be complemental for risk stratification and individualization of invasive follow-up of HTx patients with CAV.

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.