Transplant patients are among those at highest risk of adverse outcomes when receiving a stent to address a blockage in an artery. Compared with the general public, these patients have a much higher rate of restenosis, a side effect of stenting in which the artery becomes re-blocked because of an exaggerated scarring process at the stenting site.
New research by UCLA researchers and colleagues has found that heart transplant patients who develop restenosis after receiving a stent have poor long-term survival. Their study, one of the largest and longest follow-up studies of this patient population, appeared in the June 15 edition of the American Journal of Cardiology.
"The findings point to the need for improvements in prevention and treatment of transplant coronary artery disease that may help reduce restenosis for patients who require later cardiac procedures like stenting," said Dr. Michael Lee, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA.
A stenting procedure begins with an angioplasty, in which a catheter is placed in an artery of the groin and a tiny wire is snaked up through the artery to the blocked area of the heart. The clogged artery is cleaned out, and then a stent — a tiny wire-mesh tube — is passed up through the artery and deployed to keep the artery open, allowing blood to flow freely through the heart again.
Currently, there are no guidelines or treatment recommendations for in-stent restenosis for transplant coronary artery disease, Lee said. He suggests that a scoring system to help pinpoint risks might help identify good candidates for stenting and other catheter-based procedures.
For the study, Lee and his team followed 105 heart transplant patients who underwent a stent procedure at UCLA Medical Center between 1995 and 2009. Patients received either a bare metal stent or, in the later years of the study, a newer medication-coated stent that can help impede restenosis development.
The team found that patients at a seven-year follow-up who had not developed in-stent restenosis were further from an end-point of death, heart attack or repeat transplantation (63.2 percent) than patients who had developed restenosis (27.9 percent). This was primarily due to a lower survival rate in patients who developed restenosis (38.5 percent) compared to patients who did not (84.2 percent).
According to Lee, typically up to 50 percent of heart transplant patients who receive a medication-coated stent develop restenosis, compared with only 5 to 10 percent of the general population.
Researchers note that the exact mechanism that heightens the risk of death and heart attack and increases the need for additional transplant in patients with transplant coronary artery disease who develop in-stent restenosis is not known.
Lee added that organ rejection may contribute to transplant coronary disease and play a role in the increased risk of mortality. The development of blood clots in the arteries, known as intracoronary thrombus, may also contribute to mortality.
"We may find that development of restenosis in heart transplant patients may be a marker of a more aggressive inflammatory response and part of transplant rejection," Lee said.
Further studies will help better understand the role of other factors in developing transplant coronary artery disease and in-stent restenosis.
No outside funding was used for the study.
Other study authors include Richard Cheng of Ronald Reagan UCLA Medical Center, David E. Kandzari of the Piedmont Heart Institute in Atlanta, and Ajay J. Kirtane of Columbia University Medical Center/New York–Presbyterian Hospital in New York.
For more news, visit the UCLA Newsroom and follow us on Twitter.
Rachel Champeau | EurekAlert!
Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania
The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).
Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...
Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.
The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...
UMD, NOAA collaboration demonstrates suitability of in-orbit datasets for weather satellite calibration
"Traffic and weather, together on the hour!" blasts your local radio station, while your smartphone knows the weather halfway across the world. A network of...
Fiber-reinforced plastics (FRP) are frequently used in the aeronautic and automobile industry. However, the repair of workpieces made of these composite materials is often less profitable than exchanging the part. In order to increase the lifetime of FRP parts and to make them more eco-efficient, the Laser Zentrum Hannover e.V. (LZH) and the Apodius GmbH want to combine a new measuring device for fiber layer orientation with an innovative laser-based repair process.
Defects in FRP pieces may be production or operation-related. Whether or not repair is cost-effective depends on the geometry of the defective area, the tools...
10.01.2017 | Event News
09.01.2017 | Event News
05.01.2017 | Event News
16.01.2017 | Power and Electrical Engineering
16.01.2017 | Information Technology
16.01.2017 | Power and Electrical Engineering