Key result
Significant donor-transmitted CAD is not linked to all-cause mortality but is associated with higher MACE.
Why the study?
The reported prevalence of donor-transmitted coronary artery disease in heart transplantation is variable, and its prognostic impact remains unclear.
Does donor-transmitted coronary artery disease increase the risk of mortality and MACE in heart transplant recipients?
Cohort (n=937)
Yes
Does donor-transmitted coronary artery disease increase the risk of mortality and MACE in heart transplant recipients?
Hazard Ratio: 1.44 (95% CI 0.89–2.35)
p-value: p=0.141
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These data that the authors present suggest that using some of these higher-risk donors and donors with transmitted CAD is reasonable, but obviously the signal toward increased cardiovascular mortality and MACE requires further investigation and we have to be a little cautionary.”
“Our study provides some evidence regarding questions like, if we do not have the possibility to perform a coronary artery disease angiogram, should we discard these donors? And the answer is probably not.”
Significant donor-transmitted coronary artery disease in heart transplant recipients is associated with an increased risk of cardiovascular death and MACE, highlighting the prognostic importance of early post-transplant angiography.
BACKGROUND The reported prevalence of donor-transmitted coronary artery disease (TCAD) in heart transplantation (HT) is variable, and its prognostic impact remains unclear. OBJECTIVES The goal of this study was to characterize TCAD in a contemporary multicentric cohort and to study its prognostic relevance. METHODS This was a retrospective study of consecutive patients >18 years old who underwent HT in 11 Spanish centers from 2008 to 2018. Only patients with a coronary angiography (c-angio) within the first 3 months after HT were studied. Significant TCAD (s-TCAD) was defined as any stenosis ≥50% in epicardial coronary arteries, and nonsignificant TCAD (ns-TCAD) as stenosis <50%. Clinical outcomes were assessed by means of Cox regression and competing risks regression. Patients were followed-up for a median period of 6.3 years after c-angio. RESULTS From a cohort of 1,918 patients, 937 underwent c-angio. TCAD was found in 172 patients (18.3%): s-TCAD in 65 (6.9%) and ns-TCAD in 107 (11.4%). Multivariable Cox regression analysis did not show a statistically significant association between s-TCAD and all-cause mortality (adjusted HR: 1.44; 95% CI: 0.89-2.35; P = 0.141); however, it was an independent predictor of cardiovascular mortality (adjusted HR: 2.25; 95% CI: 1.20-4.19; P = 0.011) and the combined event cardiovascular death or nonfatal MACE (adjusted HR: 2.42; 95% CI: 1.52-3.85; P < 0.001). No statistically significant impact of ns-TCAD on clinical outcomes was detected. The results were similar when reassessed by means of competing risks regression. CONCLUSIONS TCAD was not associated with reduced survival in patients alive and well enough to undergo post-HT angiography within the first 3 months; however, s-TCAD patients showed increased risk of cardiovascular death and MACE.
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Couto‐Mallón et al. (2023) conducted a cohort in Heart transplant recipients (n=937). Significant donor-transmitted coronary artery disease (s-TCAD) vs. No significant donor-transmitted coronary artery disease was evaluated on All-cause mortality (HR 1.44, 95% CI 0.89-2.35, p=0.141). Significant donor-transmitted coronary artery disease was not associated with all-cause mortality (HR 1.44; 95% CI 0.89-2.35; P=0.141) but increased the risk of cardiovascular death or nonfatal MACE.
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