Prognostic impact of percutaneous coronary intervention in acute coronary syndrome vs. elective settings in heart transplant recipients

Background: Cardiac allograft vasculopathy (CAV) affects >50% of patients following heart transplantation (HTX) within ten years and is one of the main reasons for late graft failure.The study aimed to investigate the interventional and prognostic outcomes of HTX recipients undergoing percutaneous coronary intervention (PCI) for different indications.Methods: HTX recipients who underwent PCI from January 2011 until June 2023 were included retrospectively at one institution.Procedural and prognostic outcomes of these patients were evaluated comparing patients undergoing PCI for acute coronary syndrome (ACS) or elective PCI.The primary endpoint all-cause mortality at 3 years, secondary endpoint was the risk of major adverse cardiac and cerebrovascular events (MACCE).Results: One hundred fifty-nine HTX recipients undergoing PCI were included, 80% of them underwent elective PCI and 20% ACS-PCI.Dyslipidemia was more frequently observed in the elective PCI group, whereas a history of myocardial infarction was more prevalent among patients undergoing PCI for ACS.No significant difference was observed regarding the rates of technical (85.04% elective PCI vs. 87.50%ACS-PCI, p = 1.000) and procedural success (85.04% elective PCI vs. 84.38%ACS-PCI, p = 1.000).ACS-PCI was associated with an increased risk of all-cause mortality at 3 years compared to patients undergoing elective PCI after multivariable adjustment (hazard ratio (HR)=2.011,95% confidence interval (CI) 1.049 -3.856, p = 0.035) in HTX recipientsprimarily driven by higher rates of in-hospital all-cause mortality.In contrast, the rates of MACCE at 3 years were comparable between the two groups. Conclusion:In HTX recipients undergoing PCI, long-term all-cause mortality at 3 years was significantly increased in patients undergoing ACS-PCI, which was mainly attributed to higher rates of in-hospital mortality.