November 11, 2005Open Access
Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation†
Structured PICO
Do untreated residual coronary dissections after drug-eluting stent implantation increase the risk of adverse cardiovascular events?
P
Population
2,418 consecutive patients (4,630 lesions) undergoing drug-eluting stent (DES) implantation
I
Intervention
Residual coronary dissections left untreated after DES implantation
C
Comparator
No residual coronary dissection after DES implantation
O
Outcome
Major adverse cardiovascular events (MACE: composite of death, myocardial infarction, or target vessel revascularization) at in-hospital, 1-month, and 6-month follow-upcomposite
Untreated residual coronary dissections after DES implantation are associated with significantly worse clinical outcomes, including increased MACE and stent thrombosis, supporting the strategy of sealing dissection flaps.
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.