This retrospective multicenter study (Spain, 2008–2018) evaluated whether angiographically detected donor-transmitted coronary artery disease (dtCAD) — significant (≥50% stenosis) or non-significant (<50%) — independently predicts CAD progression in adult heart transplant (HT) recipients over up to 5 years post-transplant.
Both significant dtCAD (adjusted SHR 2.38; 95% CI 1.26–4.52) and non-significant dtCAD (adjusted SHR 2.92; 95% CI 1.67–5.08) were independent predictors of CAD progression; overall 5-year cumulative CAD progression incidence was 16.09%, versus progression rates of ~9.65 and 9.24 per 100 person-years for s-dtCAD and ns-dtCAD compared with 2.72 per 100 person-years in those with no dtCAD.
Retrospective design limits causal inference; only 937 of 1,918 recipients had a baseline angiogram (selection bias risk); 5-year follow-up angiograms were available in only 246 patients, reducing long-term statistical power.
Even non-significant (<50% stenosis) donor coronary disease at baseline angiogram nearly triples the risk of CAD progression after heart transplant — clinicians should flag any degree of dtCAD detected on early post-transplant angiography and consider more vigilant surveillance protocols for these recipients.
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