TY - JOUR
T1 - Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation
AU - Biondi-Zoccai, Giuseppe G L
AU - Agostoni, Pierfrancesco
AU - Sangiorgi, Giuseppe M.
AU - Airoldi, Flavio
AU - Cosgrave, John
AU - Chieffo, Alaide
AU - Barbagallo, Rossella
AU - Tamburino, Corrado
AU - Vittori, Guido
AU - Falchetti, Elena
AU - Margheri, Massimo
AU - Briguori, Carlo
AU - Remigi, Enrico
AU - Iakovou, Ioannis
AU - Colombo, Antonio
PY - 2006/3
Y1 - 2006/3
N2 - 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.
AB - 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.
KW - Antiplatelet therapy
KW - Coronary artery disease
KW - Dissection
KW - Drug-eluting stent
KW - Myocardial infarction
KW - Thrombosis
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U2 - 10.1093/eurheartj/ehi618
DO - 10.1093/eurheartj/ehi618
M3 - Article
C2 - 16284205
AN - SCOPUS:33645234335
VL - 27
SP - 540
EP - 546
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 5
ER -