Key result
Catheterization for AMI is linked to a ~19-fold greater risk of iatrogenic coronary artery-aortic dissection.
Why the study?
The incidence and characteristics of iatrogenic coronary artery dissection extending into the aortic root were not well defined.
Observational (n=43,143)
Absolute Event Rate: 0.19% vs 0.01%
p-value: p=<0.0006
Iatrogenic coronary artery dissection extending into the aortic root is a rare complication (0.02%) of cardiac catheterization, more frequent during AMI interventions, and can be managed with stenting if limited or surgery if extending >40 mm.
Requires procedural caution in AMI cases; leaves open whether modern techniques have altered this rare complication's incidence.
We set out to determine the incidence of iatrogenic coronary artery dissection extending into the aorta and to characterize the aortic lesions. We reviewed the data from 43,143 cardiac catheterizations from September 1993 through September 1999 and found 9 coronary artery-aortic dissections for an overall incidence of 0.02%. Four of these patients were undergoing treatment for acute myocardial infarction (AMI) and aortic dissection was more common than for non-AMI patients (0.19% vs. 0.01%, P < 0.0006). Histologic analysis of tissue samples from 2 cases revealed age related changes only and no evidence of predisposing pathology. Patients with limited aortic involvement were successfully managed with stenting of the coronary dissection entry point whereas aortic dissection extending up the aorta >40 mm from the coronary os required surgical intervention. Cathet. Cardiovasc. Intervent. 51:387–393, 2000.
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Dunning et al. (2000) conducted an observational in Iatrogenic coronary artery dissection (n=43,143). Treatment for acute myocardial infarction (AMI) vs. Non-AMI patients was evaluated on Iatrogenic coronary artery dissection extending into the aorta (p=<0.0006). Iatrogenic coronary artery-aortic dissection occurred in 0.02% of catheterizations, and was more common during treatment for acute myocardial infarction than non-AMI (0.19% vs. 0.01%, P<0.0006).
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