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European Heart Journal 1999 20(18):1326-1334; doi:10.1053/euhj.1999.1524
Copyright © 1999 by the European Society of Cardiology.
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Graft coronary artery disease is strongly related to the aetiology of heart failure and cellular rejections

B. Lindelöwa, C.-H. Bergha, C. Lammb, B. Anderssona and F. Waagsteina,f1

a Heart & Lung Transplantation Group, Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
b Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden

revised January 15, 1999; accepted January 20, 1999

Abstract

Aims To identify risk factors for the development of coronary artery disease after heart transplantation.

Methods and Results In consecutive heart transplanted patients, who underwent coronary angiography at the first year follow-up, the aetiology of heart failure in 113 was ischaemic heart disease or dilated cardiomyopathy. Development of clinically significant graft coronary artery disease was analysed vs recipient and donor pre- and post-transplantation variables. At 1, 5 and 9 years follow-up, coronary artery disease had developed in 4%, 16%, and 20% of the included patients, respectively. Among patients with ischaemic heart disease as the aetiology of heart failure, 38% developed graft coronary artery disease, while the corresponding figure for patients with dilated cardiomyopathy was 9% (P<0·001) during 9 years of follow-up. In multivariate regression analysis, the aetiology of ischaemic heart disease and the number of cellular rejections were independent predictors of developing graft coronary artery disease, with risk ratios of 5·8, (95% confidence interval of 2·2–14·8 (P=0·0003)) and 3·3, (95% confidence interval of 1·7–6·5 (P=0·0004)), respectively. Classical risk factors for coronary artery disease did not influence the development of graft coronary artery disease.

Conclusions Ischaemic heart disease as the aetiology of heart failure and the number of cellular rejections were powerful independent predictors of development of graft coronary artery disease following heart transplantation. The low incidence of graft coronary artery disease among patients with dilated cardiomyopathy implies that coronary angiography after heart transplantation can be made on a more selective basis.

Key Words: Coronary artery disease, risk factor, heart transplantation, graft coronary artery disease, nitroglycerin

f1 Correspondence : Finn Waagstein MD, PhD, Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

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