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

Giuseppe G L Biondi-Zoccai, Pierfrancesco Agostoni, Giuseppe M. Sangiorgi, Flavio Airoldi, John Cosgrave, Alaide Chieffo, Rossella Barbagallo, Corrado Tamburino, Guido Vittori, Elena Falchetti, Massimo Margheri, Carlo Briguori, Enrico Remigi, Ioannis Iakovou, Antonio Colombo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)540-546
Number of pages7
JournalEuropean Heart Journal
Volume27
Issue number5
DOIs
Publication statusPublished - Mar 2006

Keywords

  • Antiplatelet therapy
  • Coronary artery disease
  • Dissection
  • Drug-eluting stent
  • Myocardial infarction
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Biondi-Zoccai, G. G. L., Agostoni, P., Sangiorgi, G. M., Airoldi, F., Cosgrave, J., Chieffo, A., Barbagallo, R., Tamburino, C., Vittori, G., Falchetti, E., Margheri, M., Briguori, C., Remigi, E., Iakovou, I., & Colombo, A. (2006). Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation. European Heart Journal, 27(5), 540-546. https://doi.org/10.1093/eurheartj/ehi618