European Heart Journal Advance Access originally published online on November 11, 2005
European Heart Journal 2006 27(5):540-546; doi:10.1093/eurheartj/ehi618
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Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation
1Interventional Cardiology Unit, St Raffaele Hospital, Milan, Italy
2Institute of Medical Statistics and Biometrics, University of Milan, Milan, Italy
3Mediolanum Cardio Research, Milan, Italy
4Department of Cardiology, AZ Middelheim, Antwerpen, Belgium
5EMO Centro Cuore Columbus, via Buonarroti 48, 20145 Milan, Italy
6Interventional Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
7Interventional Cardiology, Azienda Ospedaliera Careggi, University of Florence, Florence, Italy
Received 24 February 2005; revised 29 August 2005; accepted 6 October 2005; online publish-ahead-of-print 11 November 2005.
* Corresponding author. Tel: +39 024812920; fax: +39 0248193433. E-mail address: info{at}emocolumbus.it
See page 503 for the editorial comment on this article (doi:10.1093/eurheartj/ehi681)
Aims Coronary dissections left untreated after percutaneous coronary intervention are associated with unfavourable outcomes. However, their role after drug-eluting stent (DES) implantation is still undescribed. We assessed incidence, predictors, and outcomes of residual dissections in DES-treated lesions.
Methods and results Consecutive patients undergoing DES implantation were enrolled in four Italian centres, with baseline, procedural, and outcome data entered into a dedicated database. Residual dissections were classified according to the National Heart Lung and Blood Institute criteria. End-points of interest were in-hospital, 1-month, and 6-month major adverse cardiovascular events (MACE, i.e. death, myocardial infarction, or target vessel revascularization), and stent thrombosis (ST). Among the 2418 included patients (4630 lesions), a total of 77 (1.7%) final dissections occurred in 67 (2.8%) subjects. Dissections were more frequent in longer and complex lesions and in the left anterior descending, and were associated with increased rates of in-hospital (11.9 vs. 5.2%, P=0.017) and 1-month MACE (13.4 vs. 6.0%, P=0.013), with similar 6-month trends. Cumulative ST was also greater in patients with dissections (6.3 vs. 1.3%, P=0.011). Even non-obstructive dissections with thrombolysis in myocardial infarction 3 flow conferred a significantly worse prognosis.
Conclusion This study, reporting for the first time on incidence, predictors, and outcomes of residual dissections in DES-treated coronary lesions, demonstrates their adverse clinical impact and supports the pursuit of a strategy of sealing dissection flaps with other DES.
Key Words: Antiplatelet therapy • Coronary artery disease • Dissection • Drug-eluting stent • Myocardial infarction • Thrombosis
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