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European Heart Journal Advance Access published online on November 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi618
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received February 24, 2005
Revised August 29, 2005
Accepted October 6, 2005

Clinical research

Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation

Giuseppe G.L. Biondi-Zoccai 1, Pierfrancesco Agostoni 2, Giuseppe M. Sangiorgi 3, Flavio Airoldi 4, John Cosgrave 5, Alaide Chieffo 4, Rossella Barbagallo 6, Corrado Tamburino 6, Guido Vittori 7, Elena Falchetti 7, Massimo Margheri 7, Carlo Briguori 4, Enrico Remigi 8, Ioannis Iakovou 5, Antonio Colombo 9*, and on behalf of the RECIPE (Real-world Eluting-stent Comparative Italian retrosPective Evaluation) Study Investigators

1 Interventional Cardiology Unit, St Raffaele Hospital, Milan, Italy; Institute of Medical Statistics and Biometrics, University of Milan, Milan, Italy
2 Mediolanum Cardio Research, Milan, Italy; Department of Cardiology, AZ Middelheim, Antwerpen, Belgium
3 Mediolanum Cardio Research, Milan, Italy; EMO Centro Cuore Columbus, via Buonarroti 48, 20145 Milan, Italy
4 Interventional Cardiology Unit, St Raffaele Hospital, Milan, Italy
5 EMO Centro Cuore Columbus, via Buonarroti 48, 20145 Milan, Italy
6 Interventional Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
7 Interventional Cardiology, Azienda Ospedaliera Careggi, University of Florence, Florence, Italy
8 Mediolanum Cardio Research, Milan, Italy
9 Interventional Cardiology Unit, St Raffaele Hospital, Milan, Italy; EMO Centro Cuore Columbus, via Buonarroti 48, 20145 Milan, Italy

* To whom correspondence should be addressed.
Antonio Colombo, E-mail: info{at}emocolumbus.it


  Abstract

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.

Keywords: Antiplatelet therapy; Coronary artery disease; Dissection; Drug-eluting stent; Myocardial infarction; Thrombosis.
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