Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a therapeutic option for cardiac allograft vasculopathy (CAV). Biodegradable polymer (BP)-DES, designed to promote vessel healing and reduce inflammation compared with durable polymer (DP)-DES, has been developed. In this study, we aimed to compare the efficacy of BP-DES and DP-DES in patients with CAV. METHODS: In this single-center retrospective study, we evaluated patients with CAV who underwent their first PCI between 2010 and 2024; the patients were categorized into the BP-DES and DP-DES groups. Clinical (all-cause death or heart retransplantation) and angiographic outcomes (in-stent restenosis [ISR], target lesion revascularization [TLR], target vessel revascularization [TVR], target vessel nontarget lesion revascularization [TVNLR], and nontarget vessel revascularization [NTVR]) were assessed. RESULTS: Among 178 patients who underwent PCI, 40, 106, 11 received the BP-DES, DP-DES, and both, respectively. The average age at PCI was 60.3 ± 13.1 years. Survival from all-cause death or heart retransplantation after PCI was similar between the groups (p = 0.093). Of 90 BP-DES implanted, 60 were reassessed during follow-up catheterization, whereas 171 of 221 DP-DES implanted were reassessed. Both groups exhibited similar ISR, TLR, TVR, and NTVR rates; however, the TVNLR rate was significantly lower in the BP-DES group (p = 0.049). BP-DES implantation was an independent protective factor against TVNLR (hazard ratio 0.42, 95% confidence interval 0.20-0.91, p = 0.027). CONCLUSIONS: PCI with BP-DES was associated with a lower TVNLR than PCI with DP-DES. Both DES resulted in similar clinical outcomes; however, a long-term investigation is warranted.