Coronary Collaterals Predict Improved Survival and Allograft Function in Patients with Coronary Allograft Vasculopathy

Purpose Coronary allograft vasculopathy (CAV) remains the most prevalent cause of late allograft failure following transplantation. To date there are few proven therapies for this disease. The presence of coronary collaterals has been demonstrated to impart a favorable prognosis in patients with native ischemic heart disease, however the importance of coronary collaterals in CAV is unknown. Methods and Materials To determine whether the development of coronary collaterals is associated with improved outcomes in patients with CAV, we performed a retrospective analysis of patients followed at Barnes Jewish Hospital between 1994 and 2008. The primary endpoints included all cause mortality and the composite of all cause mortality, retransplantation, and inotrope dependence. Results We screened 493 patients and identified 59 (12%) subjects with moderate to severe CAV as defined by ISHLT guidelines. Angiographically visible coronary collaterals were present in 34 (57%) subjects. Kaplan-Meier and Cox multivariable analyses revealed that patients with collaterals were protected from death and allograft failure (all cause mortality HR 0.12, 95%CI 0.05-0.29, p Conclusions Together, these data demonstrate that the presence of coronary collaterals predicts a favorable prognosis in patients with CAV and suggests that interventions aimed at promoting collateral growth may serve as effective therapies for this disease. [ figure 1 ]